Improved survival in patients with acute myocarditis using external pulsatile mechanical ventricular assistance

Chen, Jonathan M.; Spanier, Talia B.; González, John J.; Marelli, Daniel; Flannery, M.; Tector, Kelly A; Cullinane, Suzanne; Öz, Mehmet C.

doi:10.1016/s1053-2498(98)00054-0

Cited by 69 publications

(30 citation statements)

References 14 publications

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“…223 Moreover, external pulsatile mechanical ventricular assistance also improves survival in patients with acute myocarditis. 224 If myocarditis leads to end-stage HF, cardiac transplantation is the ultimate measure that should be considered. 48 Although different strategies for the therapy of myocarditis have been introduced, most are still yet to be verified in the research laboratory and are far from clinical application.…”

Section: Hf Therapymentioning

confidence: 99%

Myocarditis

Gabriel

Luo

Qiu

et al. 2016

Circulation Research

408

354

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Section: Hf Therapymentioning

confidence: 99%

Myocarditis

Gabriel

Luo

Qiu

et al. 2016

Circulation Research

408

354

View full text Add to dashboard Cite

show abstract

“…These results were quite better as compared to a previous experience with an external pulsatile ventricular assist device. In this international registry encompassing 11 patients, 7 (63%) of them survived to the explantation of the device without heart transplantation (9). Although previous investigators already emphasized on the clinical usefulness of VA-ECMO (10)(11)(12), the study of Chen et al was the first report clearly outlining the advantage of ECMO over ventricular assist devices in the specific setting of cardiogenic shock, i.e., the possibility to provide a biventricular support of easy and rapid setup even in emergent cardiopulmonary resuscitation situations.…”

Section: Introductionmentioning

confidence: 99%

Veno-arterial extracorporeal membrane oxygenation for cardiogenic shock due to myocarditis in adult patients

Pozzi¹,

Banfı²,

Grinberg³

et al. 2016

J. Thorac. Dis.

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Myocarditis is an inflammatory disease of the heart muscle with established histological, immunological and immunohistochemical diagnostic criteria. Different triggers could be advocated as possible etiologies of myocarditis such as viral and non-viral infections, medications, systemic autoimmune diseases and toxic reactions. The spectrum of clinical presentations of myocarditis is broad and varies from subclinical asymptomatic courses to refractory cardiogenic shock. The prognosis of patients with myocarditis depends mainly on the severity of clinical presentation. In particular, myocarditis patients developing cardiogenic shock refractory to optimal maximal medical treatment may benefit from the use of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) as a temporary mechanical circulatory support (MCS).The aim of the present report is to offer a review of the most important articles of the literature showing the results of VA-ECMO in the specific setting of cardiogenic shock due to myocarditis in adult patients. J Thorac Dis 2016;8(7):E495-E502 jtd.amegroups.com characterized by tissue hypoperfusion and multiorgan failure requiring prompt interventions. Initially refractory cardiogenic shock is supported with temporary MCS as a "bridge to decision" before considering the patient eligible for a long-term device implantation in case of no recovery. This general trend has been regularly highlighted by the Annual Reports of the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) (4,5). The implantation of long-term MCS in cardiogenic shock patients, i.e., INTERMACS Level 1 patients, fell since 2006 from 41% to 14%. As a consequence, there has been a considerable increase from 8% to 30% in the implantation of long-term MCS in INTERMACS Level 3 patients, i.e., stable but inotrope-dependent heart failure patients. In this subgroup of critically ill and unstable patients in cardiogenic shock, VA-ECMO allows, on the one hand, temporary hemodynamic stabilization with improvement of end-organ function and, on the other hand, gives the time to perform complementary diagnostic exams and to decide the therapeutic strategy in these high-risk candidates for immediate long-term MCS implantation (6). VA-ECMO could be implanted and removed directly at the bedside in the intensive care unit and offers a reasonable solution in term of cost-effectiveness.Patients who do not show myocardial recovery during VA-ECMO support could be directed to longterm ventricular assist device implantation or heart transplantation depending on age, general clinical and functional status, life expectancy and organs function (brain, lung, liver and kidneys). Finally, as stated by the European Society of Cardiology guidelines for the diagnosis and treatment of acute and chronic heart failure, short-term MCS should be considered (as a "bridge to recovery") in patients remaining severely hypoperfused despite inotropic therapy and with a potentially reversible cause (e.g., viral myocarditis) or a potentially ...

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“…Nevertheless complete recovery can ensue if the patient is successfully supported during the acute phase of the illness [1][2][3][4][5][6][7][8][9][10][11]. Mechanical circulatory support is a life saving approach and must be considered before multi-organ failure, but there are still many questions concerning diagnosis, time of implantation, device selection, peri-operative management and the usefulness of immunosuppressive therapy.…”

Section: Introductionmentioning

confidence: 99%

Fulminant myocarditis in adults and children: bi-ventricular assist device for recovery

Grinda

2004

European Journal of Cardio-Thoracic Surgery

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Objective: Fulminant myocarditis (FM) is uncommon and may be followed by a rapidly intractable cardiogenic shock. We report five consecutive patients with FM successfully bridged to recovery with a mechanical paracorporel biventricular assist device (BiVAD). Methods: Five patients, four adults and one child (mean age 27C/K6 years, range, 5-36 years) underwent implantation from November 1999 to May 2003, for FM. Prior to implantation, all patients required maximal inotropic support, three of them had an intra-aortic balloon pump, the child had an extra-corporel membrane oxygenation (ECMO) support previously inserted in another institution. Cardiac catheterisation showed a mean CPW of 37C/K1 mmHg, mean CVP 18C/K2 mmHg, and mean CI 1.7C/K0.1 l/min. Echocardiogram showed a severe biventricular hypokinesia, without any ventricular dilatation and a mean LVEF at 12.5%. Two patients were implanted in cardiac arrest under external cardiac resuscitation. All patients underwent BiVAD implantation (MEDOS HIA-VAD). A 72 ml right paracorporel ventricle (a 23 ml in the child) was instituted between the double stage venous canula used during CPB and a pulmonary artery outflow canula. A 80 ml left paracorporel ventricle (a 25 ml in the child) was instituted between a left ventricle apical canula and an aorta outflow canula. Results: There was no death. The mean duration support time was 11C/K6 days (from 7 to 21 days). Two patients experienced transitory deficiency due to a stroke. Four patients showed signs of FM on histological findings. Despite serologic examination and viral genome research on myocardial biopsies, pathogenic agents were not identified. At mean follow-up of 31C/K15 months, all the patients fully recovered with a mean LVEFZ60% and no left ventricular dilatation. Conclusions: In FM with intractable cardiogenic shock, the use of a BiVAD as a bridge to recovery is a life saving approach and should be considered before multi-end organ failure. q

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Improved survival in patients with acute myocarditis using external pulsatile mechanical ventricular assistance

Cited by 69 publications

References 14 publications

Myocarditis

Myocarditis

Veno-arterial extracorporeal membrane oxygenation for cardiogenic shock due to myocarditis in adult patients

Fulminant myocarditis in adults and children: bi-ventricular assist device for recovery

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