Left Ventricular Assist Devices in Patients With Active Malignancies.
JACC CardioOncol
; 3(2): 305-315, 2021 Jun.
Article
em En
| MEDLINE
| ID: mdl-34396339
ABSTRACT
BACKGROUND:
There are limited data to guide oncology and cardiology decision-making in patients with a left ventricular assist device (LVAD) and concurrent active malignancy.OBJECTIVES:
The goal of this study was to describe cancer treatment approaches, complications, and survival among patients with active cancer on LVAD support in 2 tertiary heart failure and oncology programs.METHODS:
In this retrospective cohort study, LVAD databases were reviewed to identify patients with a cancer diagnosis at the time of or after LVAD implantation. We created a 31 matched cohort based on age, sex, etiology of cardiomyopathy, LVAD implant strategy, and INTERMACS profile stratified by site. Kaplan-Meier analysis and Cox proportional hazards models were used to compare survival between patients with cancer and non-cancer comparators.RESULTS:
Among 1,123 patients who underwent LVAD implantation between 2005 and 2019, 22 patients with LVADs with active cancer and 66 matched non-cancer comparators were identified. Median age was 62 years (range 41 to 73 years); 50% of patients with cancer were African-American, and 27% were women. Prostate cancer, followed by renal cell cancer and hematologic malignancies were the most common diagnoses. There was no significant difference in unadjusted Kaplan-Meier median survival estimates from the time of LVAD placement between patients with cancer (3.53 years; 95% confidence interval [CI] 1.41 to 5.33) and non-cancer comparators (3.03 years; 95% CI 1.83 to 5.26; log-rank P = 0.99). In Cox proportional hazard models, cancer diagnosis as a time-varying variable was associated with a statistically significant increase in death (hazard ratio 2.05; 95% CI 1.03 to 4.12; P = 0.04). Patients with cancer had less gastrointestinal bleeding compared with matched non-cancer comparators (P = 0.016). Other complications were not significantly different.CONCLUSIONS:
Our study provides initial feasibility and safety data and set a framework for multidisciplinary team management of patients with cancer and LVADs.
CI, confidence interval; CMP, cardiomyopathy; CTCAE, common terminology criteria for adverse events; CVD, cardiovascular disease; DT, destination therapy; GI, gastrointestinal; HF, heart failure; LVAD, left ventricular assist device; advanced heart failure; cancer; cancer therapies; left ventricular assist device
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MEDLINE
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En
Ano de publicação:
2021
Tipo de documento:
Article