Multidisciplinary Decision-Making for LVAD Implantation in the Setting of Active Malignancy

In patients with left ventricular assist devices (LVADs), managing active malignancy is an increasing challenge for heart failure and oncology teams, according findings from a studypublished in JACC: CardioOncology.

This retrospective cohort study included patients who underwent LVAD implantation from 2005 to 2019 in 2 medical centers, 22 of whom had active cancer at the time of implantation, and 66 of whom were cancer-free and were selected as a comparison group (3:1 matching).In these patients, the median age at time of implantation was 62 years, and the groups were 73% men (50% of cancer group was Black, 41% was White; 41% of noncancer group was Black, 53% was White). Cox proportional hazard regression and Kaplan-Meier curves were used to compare mortality between the 2 groups after implantation.

The most common types of cancer diagnoses were prostate cancer (n=5), renal cell carcinoma (n=4), and hematologic malignancies (n=3). Cancer and noncancer groups did not differ significantly in terms of survival time after LVAD placement (3.53 [95% CI, 1.41-5.33] years vs 3.03 [95% CI, 1.83-5.26] years; P =.99). Cancer diagnosis was significantly associated with increased death (hazard ratio 2.05; 95% CI, 1.03-4.12; P =.04) when cancer diagnosis was treated as a time-varying variable in Cox proportional hazard models. Gastrointestinal bleeding was lower among those with cancer vs without (P =.016).

Limitations to these results include a small sample size as well as heterogeneous cancer treatment approaches, stages, and diagnoses.

The study researchers concluded that “management of active malignancy in patients on durable LVAD support represents an increasing clinical challenge for oncology and HF teams.” Further, they indicated these study results are a source of initial data on “cancer treatment, complications, and outcomes,” and provide guidance on the “creation of cancer-specific cohorts and registries of patients supported with a durable LVAD.”

Reference

Schlam I, Lee AY, Li S, et al. Left ventricular assist devices in patients with active malignancies. JACC: CardioOncology. 2021; 3(2):305-315.