Key result
Breast cancer surgery under general anesthesia is feasible without complications in severe heart failure with LVEF 21%.
Why the study?
High perioperative mortality in severe heart failure with reduced LVEF makes deciding on surgery for early-stage breast cancer challenging.
Case Report (n=1)
No
General anesthesia surgery for early breast cancer can be performed safely with careful perioperative management in patients with severe but stable heart failure (LVEF ~20%), suggesting that non-cardiac surgery should not be unnecessarily delayed due to low LVEF alone.
May support feasibility of general anesthesia in stable severe HF for breast cancer surgery; leaves open need for prospective data before broader adoption.
INTRODUCTION: Perioperative mortality is significantly higher in cases of heart failure with severe left ventricular ejection fraction (LVEF) reduction, making it challenging to decide whether to proceed with surgery for early-stage breast cancer, which is not immediately fatal. However, the prognosis of heart failure has improved and breast cancer is increasingly becoming a prognostic factor. Herein, we report the case of a breast cancer patient with severe heart failure due to dilated cardiomyopathy (DC), who was deemed fit to undergo surgery under general anesthesia after obtaining sufficient informed consent and achieving improvement in heart failure symptoms during endocrine therapy. CASE PRESENTATION: A 64-year-old female with a history of DC and sustained ventricular tachycardia, who had received cardiac resynchronization therapy with defibrillator implantation, underwent breast cancer surgery. She had been repeatedly hospitalized for heart failure with an LVEF of 19% and New York Heart Association (NYHA) Class III status, and heart transplant surgery was considered. However, a screening computed tomography scan revealed right breast cancer, and neither heart transplantation nor breast cancer surgery was performed. Endocrine therapy was initiated and failed 48 months after administration. Although the LVEF remained low at 21%, the NYHA classification improved to Class II, and she had not been hospitalized for heart failure for an extended period since her breast cancer diagnosis. Therefore, breast cancer surgery was performed under general anesthesia and no postoperative complications were observed throughout the course of the surgery. CONCLUSION: Given that the prognosis for heart failure may statistically be better than that for breast cancer, early breast cancer surgery should be performed in patients with stable heart failure symptoms.
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Oshino et al. (2025) conducted a case report in Severe heart failure due to dilated cardiomyopathy and early breast cancer (n=1). General anesthesia surgery for breast cancer was evaluated on Perioperative complications. General anesthesia surgery for early breast cancer was safely performed without perioperative complications in a patient with severe heart failure (LVEF 21%).
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