CASE REPORT Successful bridge to recovery with VAD implantation for anthracycline-induced cardiomyopathy Chitaru Kurihara • Takashi Nishimura • Kan Nawata • Osamu Kinoshita • Motoyuki Hisagi • Noboru Motomura • Shunei Kyo • Minoru Ono Received: 28 December 2010 / Accepted: 31 March 2011 / Published online: 3 May 2011 Ó The Japanese Society for Artificial Organs 2011 Abstract Anthracyclines are effective antineoplastic drugs, but they are known to be cardiotoxic. Recovery of cardiac function is rare. A few studies on implantation of a ventricular assist device (VAD) have been performed for anthracycline-induced cardiomyopathy. Recovery of left ventricular (LV) function with an LVAD is also rare. Recently, several adjunctive therapies were attempted to restore ventricular function. We report a successful bridge to recovery of ventricular function using VAD implantation for anthracycline-induced cardiomyopathy. The patient was a 57-year-old man who had been diagnosed with diffuse large B-cell lymphoma (DLBCL) at age 52. Combination che- motherapy including hydroxydaunorubicin was started. Complete remission was achieved after chemotherapy. Heart failure symptoms such as fatigue, dyspnea on exertion, and weight gain appeared 5 months later. A cardiac resynchro- nization device was implanted. His heart function deterio- rated. He underwent implantation of a Toyobo LVAD and mitral annuloplasty. After implantation, he was prescribed carvedilol with spironolactone. He was weaned from the LVAD on postoperative day (POD) 239 and discharged on POD 37 after weaning. He remained in New York Heart Association classes within the first- to second-degree range, the LV dimention diastolic/systolic ratio was 56/46 mm, ejection fraction 38%, and mitral regurgitation mild at 3 years after weaning from the LVAD. Our patient could be weaned from LVAD probably due to the combination management strategy employing mitral valvuloplasty, use of cardiac resynchronization therapy, and taking carvedilol with spironolactone. Further studies will be needed to clarify the efficacy of these adjunctive therapies. Keywords Anthracycline-induced cardiomyopathy Á Ventricular assist devices Á Bridge to recovery Introduction Anthracyclines are effective antineoplastic drugs but are cardiotoxic [1]. Their use is limited by the risk of cardio- myopathy. Anthracycline-induced cardiomyopathy is a dose-dependent adverse effect [2]. Even if cardiotoxicity does not present clinically, there is a possibility that cardiac injury is in progress and can produce congestive heart failure. The prognosis of this form of cardiomyopathy is very poor after the development of heart failure, similar to the prog- nosis of congestive heart failure or idiopathic cardiomyop- athy. Mortality rates exceed 50% within 2 years [3]. Recovery of cardiac function is rare [4]. Heart transplanta- tion is contraindicated in patients with cancer until at least 4 or 5 years after complete remission, because cancer recur- rence is not uncommon in patients taking immunosuppres- sants after heart transplantation [5]. There have been a few reports on implantation of a ventricular assist device (VAD) for severe heart failure due to anthracycline use. Recovery of ventricular function in patients with anthracycline-induced cardiomyopathy using VAD is reportedly rare [5, 6]. In our patient, we attempted adjunctive therapies known to be effective for dilated cardiomyopathy [7–10]. The patient could ultimately be weaned from the left VAD (LVAD). C. Kurihara (&) Á K. Nawata Á O. Kinoshita Á N. Motomura Á M. Ono Department of Cardiothoracic Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan e-mail: baby_star_1207@yahoo.co.jp T. Nishimura (&) Á M. Hisagi Á S. Kyo Department of Therapeutic Surgery for Heart Failure, The University of Tokyo, Tokyo, Japan e-mail: takashin-tky@umin.ac.jp 123 J Artif Organs (2011) 14:249–252 DOI 10.1007/s10047-011-0567-7