title: Heart Transplantation Under Mechanical Circulatory Support for Acute Fulminant Myocarditis With Cardiogenic Shock: 10 Years' Experience of a Single Center.
abstract: BACKGROUND
  Acute fulminant myocarditis with intractable cardiogenic shock is a fatal condition; its only therapeutic option is mechanical circulatory support. The use of mechanical circulatory support, either extracorporeal membrane oxygenation (ECMO) or a ventricular assist device (VAD), serves as a bridge to recovery or as a bridge to transplantation.
  
  
  OBJECTIVE
  The aim of this research was to advance our understanding of the outcome of heart transplantation under mechanical support for acute myocarditis. Two groups of patients were compared: those recovered without undergoing transplantation and those who underwent transplantation.
  
  
  METHODS
  We reviewed 134 patients experiencing acute myocarditis who required mechanical circulatory support (including ECMO and/or VAD) in our institute between 1994 and 2014. Demographic data, clinical characteristics, support duration, and outcome of individuals were retrospectively analyzed.
  
  
  RESULTS
  Patients taking part in this study were aged from 1 month to 70 years, with an average age of 28 years. The transplantation-free survival rate in adults was 54%. A total of 6 adult patients receive a heart transplant under ECMO/left VAD; 2 of these patients died of uncontrolled sepsis after the heart transplantation. The duration of mechanical support ranged from 10 to 130 days (average, 41 days).
  
  
  CONCLUSIONS
  Mechanical circulatory support in patients with acute myocarditis proved to be effective. Approximately one half of all adult patients in this study experienced myocardium recovery under mechanical support, with only 5% undergoing a successful heart transplantation. In terms of patients who survived after heart transplantation, the mid-term and long-term outcomes are favorable.
authors.affiliation: Cardiovascular Surgery Department, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: M
authors.initials: M
authors.lastname: Ting
authors.affiliation: Cardiovascular Surgery Department, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: C-H
authors.initials: CH
authors.lastname: Wang
authors.affiliation: Cardiovascular Surgery Department, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: C-I
authors.initials: CI
authors.lastname: Tsao
authors.affiliation: Cardiovascular Surgery Department, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: S-C
authors.initials: SC
authors.lastname: Huang
authors.affiliation: Cardiovascular Surgery Department, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: N-H
authors.initials: NH
authors.lastname: Chi
authors.affiliation: Cardiovascular Surgery Department, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: N-K
authors.initials: NK
authors.lastname: Chou
authors.affiliation: Cardiovascular Surgery Department, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Y-S
authors.initials: YS
authors.lastname: Chen
authors.affiliation: Cardiovascular Surgery Department, National Taiwan University Hospital, Taipei, Taiwan. Electronic address: wangp@ntu.edu.tw.
authors.forename: S-S
authors.initials: SS
authors.lastname: Wang
mesh_terms: D000208:Acute Disease; D000328:Adult; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D005544:Forecasting; D016027:Heart Transplantation / Q000379:methods*; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000150:complications / Q000601:surgery*; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000209:etiology / Q000601:surgery*