Breast cancer surgery under mechanical circulatory support in a patient with cancer therapy-related cardiac dysfunction: a case report.

Background: The incidence of cancer therapy-related cardiac dysfunction is increasing with the growing number of breast cancer patients. In particular, patients with active cancer combined with severe irreversible cardiac dysfunction present significant challenges in treatment decision-making. Case summary: A 40-year-old woman with Stage II HER-2-positive breast cancer received anthracycline followed by HER2-targeted agents. She developed severe heart failure due to cancer therapy-related cardiac dysfunction, with haemodynamic instability necessitating mechanical circulatory support using percutaneous cardiopulmonary support and Impella 5.5. Several weaning attempts of Impella 5.5 failed. Due to limitation for the duration of Impella support, right breast tumour resection and axillary lymph node dissection were performed under ongoing Impella support. The procedure was completed without surgical complications including significant bleeding. The patient was transferred to a specialized cardiovascular institution for possible left ventricular assist device evaluation. Discussion: This case report provides valuable insight into treatment decision-making in complex cases of irreversible cancer therapy-related cardiac dysfunction, where both oncologic and cardiologic considerations must be balanced under time-limited support devices.