title: Venoarterial Extracorporeal Membrane Oxygenation for Acute Fulminant Myocarditis in Adult Patients: A 5-Year Multi-Institutional Experience.
abstract: BACKGROUND
  Acute fulminant myocarditis (AFM) may represent a life-threatening event, characterized by rapidly progressive cardiac compromise that ultimately leads to refractory cardiogenic shock or cardiac arrest. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) provides effective cardiocirculatory support in this circumstance, but few clinical series are available about early and long-term results. Data from a multicenter study group are reported which analyzed subjects affected by AFM and treated with VA-ECMO during a 5-year period.
  
  
  METHODS
  From hospital databases, 57 patients with diagnoses of AFM treated with VA-ECMO in the past 5 years were found and analyzed. Mean age was 37.6 ± 11.8 years; 37 patients were women. At VA-ECMO implantation, cardiogenic shock was present in 38 patients, cardiac arrest in 12, and severe hemodynamic instability in 7. A peripheral approach was used with 47 patients, whereas 10 patients had a central implantation or other access.
  
  
  RESULTS
  Mean VA-ECMO support was 9.9 ± 19 days (range, 2 to 24 days). Cardiac recovery with ECMO weaning was achieved in 43 patients (75.5%), major complications were observed in 40 patients (70.1%), and survival to hospital discharge occurred in 41 patients (71.9%). After hospital discharge (median follow-up, 15 months) there were 2 late deaths. The 5-year actual survival was 65.2% ± 7.9%, with recurrent self-recovering myocarditis observed in 2 patients (at 6 and 12 months from the first AFM event), and 1 heart transplantation.
  
  
  CONCLUSIONS
  Cardiopulmonary support with VA-ECMO provides an invaluable tool in the treatment of AFM, although major complications may characterize the hospital course. Long-term outcome appears favorable with rare episodes of recurrent myocarditis or cardiac-related events.
authors.affiliation: Cardiac Surgery Unit, Spedali Civili Hospital, Brescia, Italy. Electronic address: roberto.lorussobs@gmail.com.
authors.forename: Roberto
authors.initials: R
authors.lastname: Lorusso
authors.affiliation: Molinette Hospital, Turin, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Centofanti
authors.affiliation: Cardiovascular Research Centre, Careggi Hospital, Florence, Italy.
authors.forename: Sandro
authors.initials: S
authors.lastname: Gelsomino
authors.affiliation: Cardiac Surgery Unit, S. Anna Hospital, Cuneo, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Barili
authors.affiliation: Cardiology Institute, University of L'Aquila, L'Aquila, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Di Mauro
authors.affiliation: Cardiovascular Research Centre, Careggi Hospital, Florence, Italy.
authors.forename: Parise
authors.initials: P
authors.lastname: Orlando
authors.affiliation: Cardiac Surgery Unit, Niguarda Hospital, Milan, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Botta
authors.affiliation: Cardiac Surgery Unit, Niguarda Hospital, Milan, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Milazzo
authors.affiliation: Mauriziano Hospital, Turin, Italy.
authors.forename: Guglielmo
authors.initials: G
authors.lastname: Actis Dato
authors.affiliation: Mauriziano Hospital, Turin, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Casabona
authors.affiliation: S. Camillo Hospital, Rome, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Casali
authors.affiliation: S. Camillo Hospital, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Musumeci
authors.affiliation: S. Raffaele Hospital, Milan, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: De Bonis
authors.affiliation: S. Raffaele Hospital, Milan, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Zangrillo
authors.affiliation: S. Raffaele Hospital, Milan, Italy.
authors.forename: Ottavio
authors.initials: O
authors.lastname: Alfieri
authors.affiliation: S. Matteo Hospital, Pavia, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Pellegrini
authors.affiliation: S. Matteo Hospital, Pavia, Italy.
authors.forename: Sandro
authors.initials: S
authors.lastname: Mazzola
authors.affiliation: Cardiac Surgery Unit, Spedali Civili Hospital, Brescia, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Coletti
authors.affiliation: Cardiology Unit, Spedali Civili Hospital, Brescia, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Vizzardi
authors.affiliation: Cardiac Surgery Unit, University Hospital, Padua, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Bianco
authors.affiliation: Cardiac Surgery Unit, University Hospital, Padua, Italy.
authors.forename: Gino
authors.initials: G
authors.lastname: Gerosa
authors.affiliation: Gemelli Hospital, Rome, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Massetti
authors.affiliation: Gemelli Hospital, Rome, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Caldaroni
authors.affiliation: S. Orsola Hospital, Bologna, Italy.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Pilato
authors.affiliation: S. Orsola Hospital, Bologna, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Pacini
authors.affiliation: S. Orsola Hospital, Bologna, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Di Bartolomeo
authors.affiliation: S. Orsola Hospital, Bologna, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Marinelli
authors.affiliation: S. Maria Misericordia Hospital, Udine, Italy.
authors.forename: Sandro
authors.initials: S
authors.lastname: Sponga
authors.affiliation: S. Maria Misericordia Hospital, Udine, Italy.
authors.forename: Ugolino
authors.initials: U
authors.lastname: Livi
authors.affiliation: Molinette Hospital, Turin, Italy.
authors.forename: Rinaldi
authors.initials: R
authors.lastname: Mauro
authors.affiliation: Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Leicester, United Kingdom.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Mariscalco
authors.affiliation: University Hospital, Varese, Italy.
authors.forename: Cesare
authors.initials: C
authors.lastname: Beghi
authors.affiliation: Pasquinucci Hospital Fondazione Monasterio, Massa, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Miceli
authors.affiliation: Pasquinucci Hospital Fondazione Monasterio, Massa, Italy.
authors.forename: Mattia
authors.initials: M
authors.lastname: Glauber
authors.affiliation: S. Raffaele Hospital, Milan, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Pappalardo
authors.affiliation: Cardiac Surgery Unit, Niguarda Hospital, Milan, Italy.
authors.forename: Claudio Francesco
authors.initials: CF
authors.lastname: Russo
mesh_terms: D000208:Acute Disease; D000328:Adult; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D009205:Myocarditis / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome