Cancer in end-stage heart failure patients supported by left ventricular assist devices

摘要

The percentage of elderly patients receiving left ventricular assist devices (LVADs) has increased; thus, a rise in the frequency of elderly prevalent diseases would be expected in LVAD-supported patients. Cancer is the second leading cause of death in the United States, and the frequency of cancer and the mortality rate of malignancies increase with age. We describe the clinical characteristics of eight patients who were diagnosed of cancer after LVAD implantation. Skin, esophageal, central nervous system (CNS), hematological and renal malignancies were observed. After careful consideration, these patients underwent surgical resections, radiotherapy, radiofrequency ablation, and chemotherapy with variable results. Patients who developed cancer were older males who received LVAD predominantly as destination therapy. Skin cancer and hematological malignancy were managed with standard oncologic treatment. Renal cell carcinoma was monitored, and a CNS tumor was treated aggressively but as expected had a poor outcome. Esophageal cancer, although localized, represented a serious therapeutic challenge, as patients were unable to undergo a potentially curative surgical procedure because of the anatomic location of malignancy. More information is needed regarding the outcomes and best treatment strategies for this newly identified population.