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Originally published June 25, 2025
Last updated June 25, 2025
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When an adverse reaction to chemotherapy sent a patient into heart failure, it took state-of-the-art treatment from an advanced cardiovascular team to save him in time.
Leaders from the USC Advanced Heart Failure Center, part of the USC Cardiac and Vascular Institute and Keck Medicine of USC, alongside cardiothoracic surgery and cardiovascular critical care specialists, explain how their minute-by-minute coordination made it possible for the patient to ultimately undergo the first procedure of its kind in Los Angeles: a solution some refer to as the HeartMate6, which is essentially implantation of a HeartMate 3TM left ventricular assist device (LVAD) on both the left and right sides of the heart.
The patient was a male in his early 40s who, in late 2024, was diagnosed with Non-Hodgkin lymphoma at a medical center not related to Keck Medicine. He underwent chemotherapy for several months, with his lymphoma responding well to treatment. Prior to chemotherapy, the patient had undergone echocardiogram testing that showed his heart function and ejection fraction as normal.
Once chemotherapy ended, however, the patient began experiencing trouble breathing and fatigue. He went to an urgent care clinic, which prescribed antibiotics and steroids, thinking the cause might be bronchitis or pneumonia. When the patient’s symptoms worsened instead of improving, however, he went to an emergency room, where he was diagnosed with heart failure.
The patient’s heart failure was acute, with rapidly progressing cardiogenic shock and poor perfusion to his kidneys and liver. Aware of the seriousness, the patient reached out to a physician he knew professionally from Keck Medicine and its USC Cardiac and Vascular Institute, and the patient was quickly transferred to Keck Hospital of USC.
The patient’s severe biventricular heart failure, which impacted both the left and right sides of his heart, turned out to be a rare reaction to a chemotherapy agent he had received during cancer treatment. In most patients, any cardiotoxicity from this chemotherapy drug will develop gradually over the course of years, even decades. But in this patient’s case, his adverse reaction was accelerated such that it could cause heart damage in just weeks or months.
At Keck Hospital, critical care experts specializing in cardiovascular treatment worked feverishly to first stabilize the patient, who was quickly declining and could not yet tolerate any kind of surgery. Among initial treatments, he was put on two high-dose inotropes to support his heart function. When blood flow to his organs was still insufficient, an intra-aortic balloon pump (IABP) was introduced to further stabilize blood flow from the heart.
This part of his treatment was led by anesthesiologist and critical care medicine specialist Anahat Dhillon, MD, medical director of cardiovascular critical care, with anesthesiologist and critical care specialist Krisztina Escallier, MD, running point.
Getting the patient stabilized in the ICU took a village, Escallier says. The entire multidisciplinary team of Keck Medicine cardiovascular specialists was in constant communication, trying to improve the patient’s condition so he could proceed with surgery. “We spent a lot of time putting our heads together, taking it hour by hour and day by day,” Escallier says.
Patients with biventricular heart failure have limited treatment options. This patient’s complications from cancer treatment shrank those options further.
The physicians who led the next phase of treatment included leaders from the USC Advanced Heart Failure Center: Ajay Vaidya, MD, medical director of the center’s Heart Failure, Heart Transplantation and Mechanical Circulatory Support Program, and Raymond Lee, MD, the program’s surgical director. Jonathan Praeger, MD, a Keck Medicine cardiothoracic surgeon and associate director of mechanical circulatory support, performed the procedure.
The ideal treatment, a heart transplant, wasn’t viable at the time. A transplant would have required the patient to receive high-dose immunosuppression, but since he had just completed chemotherapy treatment, this route was deemed too risky.
The best alternative was to implant the patient with a mechanical circulatory support device to bolster his heart function until he could become healthy enough to be eligible for a transplant, which would likely take at least a year to be cleared from his cancer to be eligible for heart transplant.
Doctors weighed several mechanical circulatory support options. They discussed using a temporary right ventricular assist device (t-RVAD), but this temporary device would have required the patient to remain in the hospital, which the patient didn’t want because he had young children at home. Another option was to implant an LVAD only on the left side of the heart and to try to support the right side through inotrope medication alone. However, since the patient had continued to decline even after receiving inotropes in the ICU, his physicians opted for a different approach.
Their ultimate solution was an unusual one: to implant two HeartMate 3 LVADs, one on each side of the patient’s heart. As its name implies, an LVAD is typically designed for the left ventricle only. This off-label usage is what some in the field refer to as a HeartMate 6 device.
Vaidya explains: “Ultimately, the decision was made that it would be better to support the patient’s heart with mechanical devices — HeartMate 3 LVADs on both the left and the right — so that he could go home and see if his heart function would recover. Then, down the road, he could be considered for a heart transplant.”
He adds: “There aren’t a lot of mechanical circulatory support devices that allow patients with biventricular heart failure to transition from hospital to home. The bilateral HeartMate 3 LVADs were the only way this patient could survive outside the hospital.”
Notably, this is the first HeartMate 6 procedure performed in the Los Angeles area — a milestone for the Keck Medicine team. Lee says it has only been performed a dozen times or so in the United States.
Placing the HeartMate 3 LVAD in the patient’s left ventricle was fairly standard. However, to place the LVAD on the right side of the patient’s heart, modifications were required.
On the right side of the heart, the LVAD was placed in the atrium instead of the ventricle. Praeger explains: “There’s no difference in the pump itself; it’s the exact same machine on both sides of the heart. Essentially, it’s still an inflow where the blood gets received and gets pumped out into the outflow. On the left side, it’s inflow from the left ventricle out to the aorta. On the right side, it’s right atrium out to the pulmonary artery.”
Because blood flows slower on the right side of the heart, there was a risk of blood clotting and building up within the LVAD as it flowed through the device. To prevent this, the team also installed a “donut device” on the right-side LVAD — a thick, Teflon ring placed around the pump’s cannula to facilitate blood flow.
The entire surgery, which took three hours, went smoothly — and just in time. Prior to being rushed into the OR, the patient’s respiratory, liver and kidney functions were failing. “The complexity of this case — the fact that this patient was extremely sick going into the operation, and we were really rushing to the operating room — was uncommon,” Praeger says.
Vaidya adds: “The morning the patient was ready to go to the operating room, I was on the phone with Dr. Praeger and Dr. Lee, telling them we needed to go into surgery right away. The patient was potentially hours away from death. Luckily, we were able to quickly mobilize and assemble specialists, including heart failure and IC doctors.”
All agree that the surgery itself wasn’t even the most difficult part of treatment. “The most complex part about this case was all the coordination between the heart failure doctors, cardiac surgeons, intensivists, nurses, LVAD coordinators, preoperative coordinators and postoperative coordinators,” Praeger explains. “That team effort was the most impressive achievement, in my opinion. Knowing we had a comprehensive cardiovascular team was part of the reason we took on such a high-risk operation in the first place, because we had faith in our team’s expertise.”
Lee agrees. “I think the most important thing is that the team together made treatment decisions quickly. The surgery went smoothly. He did not bleed postoperatively. His postoperative course was very smooth, which made a big difference. We were able to anticoagulate him very quickly.”
Post-surgery, the patient, while still ill, was on the path to healing, including regaining organ function. “He recovered very quickly in the days after the operation,” Vaidya says. “He got started on continuous dialysis, and within 24-48 hours, he started producing urine and was off dialysis. His liver and kidneys also improved. He spent a couple of weeks in the hospital for rehabilitation to get stronger ad then went home relatively quickly. Since he’s been at home, he’s been doing really well. He’s already come to clinic several times.”
A pulmonary artery sensor was also implanted in the patient to allow the team to remotely monitor pressure in his lungs.
“Fortunately, this smooth post-op course — getting him up, getting him better, recovering all his organs so quickly and getting him home — will give him the best chance of moving forward and hopefully to transplant,” Lee says.
Without the quick actions and expertise of the many cardiovascular specialists at Keck Medicine, this patient would likely have died, the physicians say.
“If the patient hadn’t received this procedure, if we had done nothing, he would have certainly died,” Vaidya says. “Ultimately, given the lack of options and his and our desire to get him out of the hospital, we quickly settled on doing something that has never been done in Los Angeles and that gives him a shot at life.”
The patient continues getting stronger each week, the physicians report. “The long-term plan for him is likely a heart transplant,” Vaidya says. Within a year or two on the LVADs, the team hopes he is deemed cancer free and can tolerate immunosuppression for a heart transplant.
“Once he recovers from this, gets stronger, allows his chest and his sternum to heal and then is ultimately restaged for cancer — getting imaging tests and a workup by his oncologist to see where his cancer is — he will then start a workup for a heart transplant again,” Vaidya says. “Until then, this is a meaningful time during which he gets to be at home with his family.”
The main takeaway of this case for physicians, especially when it comes to patients with complex conditions, is to get patients to an advanced cardiovascular center for assessment as quickly as possible, Lee says. The physicians in this case credit heart failure and transplant cardiologist Aaron M. Wolfson, MD, of the USC Cardiac and Vascular Institute, whom the patient knew, for helping get the patient rapidly transferred to Keck Hospital at the start.
“Because this patient came to our center promptly, our entire specialty team was there to make the best treatment decisions possible and to pivot — especially whenever he began declining quickly,” Lee says. “If he had been at a different hospital, I would not have had Dr. Vaidya, Dr. Praeger, Dr. Dillon, Dr. Escallier and all the other cardiovascular specialists to work with. Everyone here understands how to take care of very complex, very sick patients, and that’s why this patient was able to have such a smooth post-op course.”
Praeger agrees. “The surgery sometimes outshines the fact that early diagnosis and getting into an advanced center early is just as important as the surgery itself.”
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