Mechanical circulatory support for fulminant myocarditis

Abstract

Since severe and rapid hemodynamic compromise is typical of fulminant myocarditis, an immediate decision must be made about whether to initiate MCS. We attribute the excellent results and favorable long-term prognosis of our patients to the early initiation of MCS.

Venoarterial Extracorporeal Membrane Oxygenation for Acute Fulminant Myocarditis in Adult Patients: A 5-Year Multi-Institutional Experience

“…McCarthy and collaborators [29] have claimed that AFM has a more favorable prognosis than other forms of [5] 1989-2000 52 42 (80.7) 31 (59.6) NA Chen et al [9] 1994-2001 15 14 (93) 11 (73) NA Asaumi et al [13] 1993-2001 6 4 (67) 4 (67) NA Maejima et al [14] 1991-2000 8 NA 6 (75) 100 (range, 1.4-5.9) Sezai et al [20] 1999-2006 7 7 (100) 7 (100) NA Pages et al [6] 2001 acute myocarditis, showing a 1-year survival and freedom from heart transplantation of 93% in 15 patients. However, this experience was characterized by the need of aggressive mechanical circulatory support in only 2 patients during initial hospitalization; the remaining patients were successfully treated with medical therapy only, suggestive of less critical conditions in these subjects compared with our patient cohort.…”

Successive Circulatory Support Stages: A Triple Bridge to Recovery from Fulminant Myocarditis

“…Arguments in favor of BiVAD support are better unloading of ventricles, a primary condition for recovery from fulminant myocarditis, and avoidance of significant morbidities associated with prolonged ECMO support. 3,10,12,13 Longer-term BiVADs are indicated if cardiac recovery time is extended and patient rehabilitation and ambulation is necessary. Patients with the Thoratec p-VAD device may also be discharged to home while recovering or awaiting transplantation.…”

“…For those who progress to hemodynamic instability, circulatory support is necessary. 2 For patients who do need mechanical circulatory support, it has been postulated that ECMO should be preferred due to short recovery time expectations, 5,6,8,11,12 the ability to provide global cardiopulmonary support, and for ease of weaning. Arguments in favor of BiVAD support are better unloading of ventricles, a primary condition for recovery from fulminant myocarditis, and avoidance of significant morbidities associated with prolonged ECMO support.…”

Acute myocarditis in children

“…Patients may have a flu-like prodome -including fever -and are ill-appearing upon presentation, sometimes without obvious cardiacrelated symptoms [18]. Patients with fulminant Review myocardits are more likely to present with conduction delays, ventricular tachycardia and decreased left ventricular systolic function [19,20]. Some patients may require temporary external pacing for atrioventricular block.…”