Circulatory support for fulminant myocarditis: consideration for implantation, weaning and explantation.
OBJECTIVE
Fulminant myocarditis (FM) is an uncommon but life-threatening condition for which a mechanical circulatory support (MCS) device can be life-saving. However, device selection, weaning and explantation procedures remain poorly defined.


METHODS
Four patients were bridged to recovery using the Thoratec biventricular support device. All four were in a state of cardiogenic shock with rapid deterioration of their clinical status despite increasing doses of inotropes. Three patients required mechanical respiratory support, three were anuric and one was dialyzed. Echocardiography showed a mean ejection fraction of 12+/-8%.


RESULTS
Each Thoratec implantation was performed on cardiopulmonary bypass with a beating heart. Three patients underwent biventricular cannulation. The fourth patient underwent left ventricular and right atrial cannulation. All patients manifested evidence of moderate to severe end organ dysfunction after device implantation. However, by explantation, end organ function had recovered in all patients. After a mean duration of 17+/-10 days, all the patients showed evidence of myocardial recovery. Recovery was confirmed on echocardiography which showed opening of the aortic valve and contraction of both ventricles. The weaning process was performed in 2-5 days by setting the device in a fixed mode and increasing the rate. Device explantation was uneventful in the four patients. At the 6 months echocardiography follow-up, all had normal systolic function.


CONCLUSIONS
In patients with FM, biventricular support allows full circulatory support and unloads both ventricles until recovery occurs. In this set of patients, weaning and removal procedures are straight-forward. These results suggest an aggressive stance toward implantation of MCS in patients with FM.
Leprince
Pascal
P
Service de Chirurgie Thoracique et Cardiovasculaire, Groupe Pitié-Salpétrière, Institut de Cardiologie, 47-83 Boulevard de l'hôpital, 75013 Paris, France. pascal.leprince@psl.ap-hop-paris.fr
Combes
Alain
A
Bonnet
Nicolas
N
Ouattara
Alexandre
A
Luyt
Charles Edouard
CE
Theodore
Pierre
P
Léger
Philippe
P
Pavie
Alain
A
D000328:Adult; D002315:Cardiopulmonary Bypass; D020878:Device Removal / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D009205:Myocarditis / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D012770:Shock, Cardiogenic / Q000209:etiology / Q000628:therapy; D014463:Ultrasonography