title: Recovery of ventricular function with a left ventricular axial pump in a patient with end-stage toxic cardiomyopathy not a candidate for heart transplantation: first experience in Spain.
abstract: BACKGROUND
  Toxic cardiomyopathies are rare and the most frequent cause are anthracycline compounds. Early acute toxicity can be reversible, but at present the only effective therapy for late end-stage anthracycline cardiomyopathy seems to be a heart transplantation. Currently, this transplantation is contraindicated in cases of cancer, at least during the first 4 or 5 years. Recently, implantable axial pumps have shown good results and are used with increasing frequency as destination therapy.
  
  
  METHODS
  We present a case of end-stage heart failure due to a toxic cardiomyopathy after a bilateral breast cancer treated with resection and chemotherapy (doxorubicin and trastuzumab). Ejection fraction was 23% with dobutamine. A left ventricular axial pump (Incor) was implanted.
  
  
  RESULTS
  The immediate postoperative course was uneventful. The left ventricular function improved and on the fourth month the ejection fraction was 55%. On postoperative day 135, the pump was explanted. After 1.5 years, the patient is doing well, with an ejection fraction of 57%.
  
  
  CONCLUSIONS
  This is the first application of an implantable axial pump in Spain. Although toxic cardiomyopathies are rare, in cases of late end-stage left ventricular failure and when the heart transplantation is contraindicated, the implantation of an axial pump can be the solution. The results in previous cases are unknown, although it is possible, as in our case.
authors.affiliation: Department of Cardiac Surgery, Bellvitge University Hospital IDIBELL, Hospitalet de Llobregat, Barcelona, Spain. castellscuch@bellvitgehospital.cat
authors.forename: E
authors.initials: E
authors.lastname: Castells
authors.forename: J
authors.initials: J
authors.lastname: Roca
authors.forename: A
authors.initials: A
authors.lastname: Miralles
authors.forename: N
authors.initials: N
authors.lastname: Manito
authors.forename: D
authors.initials: D
authors.lastname: Ortiz
authors.forename: J
authors.initials: J
authors.lastname: Gonzalez
authors.forename: J
authors.initials: J
authors.lastname: Granados
authors.forename: M
authors.initials: M
authors.lastname: Benito
authors.forename: M
authors.initials: M
authors.lastname: Rabasa
authors.forename: F
authors.initials: F
authors.lastname: S'braga
authors.forename: J
authors.initials: J
authors.lastname: Toscano
authors.forename: D
authors.initials: D
authors.lastname: Toral
authors.forename: A
authors.initials: A
authors.lastname: López
authors.forename: C
authors.initials: C
authors.lastname: Fontanillas
mesh_terms: D000328:Adult; D018943:Anthracyclines / Q000633:toxicity; D001943:Breast Neoplasms / Q000150:complications; D009202:Cardiomyopathies / Q000139:chemically induced / Q000150:complications* / Q000473:pathology / Q000601:surgery; D018450:Disease Progression; D005260:Female; D016027:Heart Transplantation / Q000706:statistics & numerical data*; D006353:Heart-Assist Devices; D006801:Humans; D018579:Patient Selection; D019736:Prostheses and Implants; D013030:Spain; D016896:Treatment Outcome
chemical_list: D018943:Anthracyclines