title: Acute mechanical circulatory support for fulminant myocarditis complicated by cardiogenic shock.
abstract: In fulminant myocarditis complicated by cardiogenic shock, early mechanical circulatory support (MCS) may prevent cardiomyopathy and death. We sought to examine the outcomes of patients with fulminant myocarditis supported with MCS. A retrospective review of patients with acute cardiogenic shock treated with MCS from 2007 to 2013 was conducted, and patients with a diagnosis of fulminant myocarditis were included in this series. At our center, 260 patients received MCS for acute cardiogenic shock, and 11 were implanted for fulminant myocarditis. Eight received the Centrimag biventricular assist device (BIVAD), and three received veno-arterial extracorporeal membrane oxygenator (VA ECMO), though 1 VA ECMO-supported patient was transitioned to BIVAD due to refractory shock. The mean acute support time was 14.7 ± 4.4 days. Two patients required long-term left ventricular assist devices and were further supported for 55 and 112 days. Eight patients recovered with a mean ejection fraction of 54 ± 7 %, and one was successfully transplanted. Eight patients survived to discharge (73 %) with mean follow-up: 292.6 ± 306.8 days. All three deaths were due to neurologic complications. MCS should be considered in patients with fulminant myocarditis complicated by shock. With aggressive medical therapy, early utilization of MCS carries promising outcomes.
authors.affiliation: Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, 10032, USA.
authors.forename: Kanika P
authors.initials: KP
authors.lastname: Mody
authors.forename: Hiroo
authors.initials: H
authors.lastname: Takayama
authors.forename: Elissa
authors.initials: E
authors.lastname: Landes
authors.forename: Melana
authors.initials: M
authors.lastname: Yuzefpolskaya
authors.forename: Paolo C
authors.initials: PC
authors.lastname: Colombo
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; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000401:mortality; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D011474:Prosthesis Design; D020127:Recovery of Function; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left; D055815:Young Adult