Use of a biventricular assist device in the treatment of acute doxorubicin-induced cardiotoxicity.
This report describes a patient treated for metastatic leiomyosarcoma, who acutely developed doxorubicin-induced cardiotoxicity, and consequently developed heart failure. Medical therapy was initiated; however, her condition deteriorated and a surgical alternative was proposed. A biventricular assist device was implanted, allowing her multisystem organ failure to improve. During the next 9 days while on the assist device, her heart failure resolved, her organs were well perfused, and her heart entered a recovery period. After 9 days of mechanical support with the biventricular assist device, she was explanted from the assist device, and with inotropic support and an intra-aortic balloon pump, she maintained adequate hemodynamics. Eighteen days after implantation of the assist device, she was discharged from the hospital with hospice care, where she later died. Although the patient's cardiac function did not have long-term recovery, short-term recovery after doxorubicin toxicity was achieved. The authors maintain that the use of a biventricular assist device in the treatment of acute heart failure resulting from doxorubicin-induced cardiomyopathy is an effective way to manage this patient population.
State University of New York Upstate Medical University, University Hospital, Department of Cardiothoracic Surgery, 750 East Adams Street, Syracuse, NY 13213, USA. swartzm@upstate.edu
Michael F
MF
Swartz
Gregory W
GW
Fink
Robert L
RL
Carhart
D000208:Acute Disease; D000328:Adult; D000903:Antibiotics, Antineoplastic / Q000009:adverse effects*; D002318:Cardiovascular Diseases / Q000139:chemically induced* / Q000628:therapy; D004317:Doxorubicin / Q000009:adverse effects*; D017809:Fatal Outcome; D005260:Female; D006333:Heart Failure / Q000628:therapy; D006353:Heart-Assist Devices; D006801:Humans; D007890:Leiomyosarcoma / Q000188:drug therapy; D013727:Terminal Care
D000903:Antibiotics, Antineoplastic; D004317:Doxorubicin