Left Ventricular Assist Devices in Patients With Active Malignancies

Ilana Schlam; Andy Y Lee; Song Li; Farooq H Sheikh; Raja Zaghlol; Binaya Basyal; Christopher Gallagher; Ezequiel Molina; Claudius Mahr; Richard K Cheng; Ana Barac

doi:10.1016/j.jaccao.2021.04.008

Left Ventricular Assist Devices in Patients With Active Malignancies

JACC CardioOncol. 2021 Jun 15;3(2):305-315. doi: 10.1016/j.jaccao.2021.04.008. eCollection 2021 Jun.

Authors

Ilana Schlam^{1

2}, Andy Y Lee³, Song Li³, Farooq H Sheikh^{4

5

6}, Raja Zaghlol⁷, Binaya Basyal^{4

5

6}, Christopher Gallagher^{1

2}, Ezequiel Molina^{4

5

6}, Claudius Mahr³, Richard K Cheng³, Ana Barac^{4

5

6}

Affiliations

¹ MedStar Washington Cancer Institute, Washington, DC, USA.
² Department of Hematology-Oncology, MedStar Washington Hospital Center, Washington, DC, USA.
³ Department of Cardiology, University of Washington Medical Center, Department of Cardiology, Seattle, Washington, USA.
⁴ MedStar Heart and Vascular Institute, Washington, DC, USA.
⁵ Department of Cardiology, MedStar Washington Hospital Center, Washington, DC, USA.
⁶ Georgetown University, Washington, DC, USA.
⁷ Internal Medicine Department, MedStar Washington Hospital Center, Washington, DC, USA.

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 3:1 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.

Keywords: 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.