title: Ventricular assist device support as a bridge to heart transplantation in patients with giant cell myocarditis.
abstract: OBJECTIVE
  Giant cell myocarditis (GCM) carries a poor prognosis and many patients require end-stage therapies. This study sought to determine the outcome of patients bridged with ventricular assist devices (VAD) to orthotopic heart transplantation (OHT).
  
  
  RESULTS
  A retrospective data collection of all patients with GCM was performed. Diagnosis was determined by endomyocardial or explanted heart biopsy. Eight patients were found, but two of those patients went directly to OHT and were excluded. The remaining six patients received VADs, and these patients, aged 44 ± 18 years, were included. Five of the six patients were bridged with biventricular support and one patient was supported by left ventricular assist device (LVAD) alone. Two patients died on device support. Four patients were bridged to OHT 77 ± 42 days after device implantation. All four patients bridged with a VAD are alive, with a mean follow-up of 5.7 ± 4.1 years. Two patients were found to have recurrent GCM in the transplanted heart and were treated successfully with immunosuppression. Three patients had high grade (2R) rejection at 66 ± 52 days post-OHT. Cardiac function was preserved in all patients, and only one patient had cardiac allograft vasculopathy.
  
  
  CONCLUSIONS
  Patients with end-stage GCM can be successfully bridged with VADs to OHT with very good post-OHT survival. The proper immunosuppressive regimen for this group needs further investigation given the frequency of rejection and GCM recurrence.
authors.affiliation: Department of Medicine, Columbia University, New York, NY 10032, USA.
authors.forename: Lindsay K
authors.initials: LK
authors.lastname: Murray
authors.forename: Jose
authors.initials: J
authors.lastname: González-Costello
authors.forename: Samual N
authors.initials: SN
authors.lastname: Jonas
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Sims
authors.forename: Kerry A
authors.initials: KA
authors.lastname: Morrison
authors.forename: Paolo C
authors.initials: PC
authors.lastname: Colombo
authors.forename: Donna M
authors.initials: DM
authors.lastname: Mancini
authors.forename: Susan W
authors.initials: SW
authors.lastname: Restaino
authors.forename: Evan
authors.initials: E
authors.lastname: Joye
authors.forename: Evelyn
authors.initials: E
authors.lastname: Horn
authors.forename: Hiroo
authors.initials: H
authors.lastname: Takayama
authors.forename: Charles C
authors.initials: CC
authors.lastname: Marboe
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Naka
authors.forename: Ulrich P
authors.initials: UP
authors.lastname: Jorde
authors.forename: Nir
authors.initials: N
authors.lastname: Uriel
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D016027:Heart Transplantation / Q000295:instrumentation*; D006352:Heart Ventricles; D006353:Heart-Assist Devices; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000601:surgery / Q000628:therapy*; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents