Inflammatory Cardiomyopathy (ICM): Long-Term Survival after Heart Transplantation or Implantation of Mechanical Circulatory Support

Esmaily, S.; Bobbio, Emanuele; Bollano, Entela; Dahlberg, Pia; Bartfay, Sven‐Erik; Dellgren, Göran; Karason, Kristjan

doi:10.1016/j.healun.2019.01.733

Cited by 2 publications

(1 citation statement)

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“…Since patients with GCM have a similar post-transplant survival [22] as patients with all other heart diseases treated with OHT, bridging patients to transplant is crucial and valuable. Another reported benefit [16] of MCS is its ability to support the ventricle if it becomes irritated after EMB, the gold-standard [23] for GCM diagnosis. Early biopsy is critical for patients with suspected GCM, given that rates of transplant and death have been reported [17] as high as 80% to 100% in patients who do not receive a biopsy.…”

Section: Discussion Of Clinical Significancementioning

confidence: 99%

Outcomes of Mechanical Circulatory Support for Giant Cell Myocarditis: A Systematic Review

Patel

Saxena

Wood

et al. 2020

JCM

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Treatment of giant cell myocarditis (GCM) can require bridging to orthotopic heart transplantation (OHT) or recovery with mechanical circulatory support (MCS). Since the roles of MCS and immunotherapy are not well-defined in GCM, we sought to analyze outcomes of patients with GCM who required MCS. A systematic search was performed in June 2019 to identify all studies of biopsy-proven GCM requiring MCS after 2009. We identified 27 studies with 43 patients. Patient-level data were extracted for analysis. Median patient age was 45 (interquartile range (IQR): 32–57) years. 42.1% (16/38) were female. 34.9% (15/43) presented in acute heart failure. 20.9% (9/43) presented in cardiogenic shock. Biventricular (BiVAD) MCS was required in 76.7% (33/43) of cases. Of the 62.8% (27/43) of patients who received immunotherapy, 81.5% (22/27) used steroids combined with at least one other immunosuppressant. Cyclosporine was the most common non-steroidal agent, used in 40.7% (11/27) of regimens. Immunosuppression was initiated before MCS in 59.3% (16/27) of cases, after MCS in 29.6% (8/27), and not specified in 11.1% (3/27). Immunosuppression started prior to MCS was associated with significantly better survival than MCS alone (p = 0.006); 60.5% (26/43) of patients received bridge-to-transplant MCS; 39.5% (17/43) received bridge-to-recovery MCS; 58.5% (24/41) underwent OHT a median of 104 (58–255) days from diagnosis. GCM recurrence after OHT was reported in 8.3% (2/24) of transplanted cases. BiVAD predominates in mechanically supported patients with GCM. Survival and bridge to recovery appear better in patients on immunosuppression, especially if initiated before MCS.

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