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. Method. 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. (C) 2016 by The Society of Thoracic Surgeons

Lorusso, R., Centofanti, P., Gelsomino, S., Barili, F., Di Mauro, M., Orlando, P., Botta, L., Milazzo, F., Actis Dato, G., Casabona, R., Casali, G., Musumeci, F., De Bonis, M., Zangrillo, A., Alfieri, O., Pellegrini, C., Mazzola, S., Coletti, G., Vizzardi, E., Bianco, R., Gerosa, G., Massetti, M., Caldaroni, F., Pilato, E., Pacini, D., Di Bartolomeo, R., Marinelli, G., Sponga, S., Livi, U., Mauro, R., Mariscalco, G., Beghi, C., Miceli, A., Glauber, M., Pappalardo, F., Russo, C. F., Venoarterial Extracorporeal Membrane Oxygenation for Acute Fulminant Myocarditis in Adult Patients: A 5-Year Multi-Institutional Experience, <<ANNALS OF THORACIC SURGERY>>, 2016; 101 (3): 919-926. [doi:10.1016/j.athoracsur.2015.08.014] [http://hdl.handle.net/10807/74432]

Venoarterial Extracorporeal Membrane Oxygenation for Acute Fulminant Myocarditis in Adult Patients: A 5-Year Multi-Institutional Experience

Massetti, Massimo;
2016

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. Method. 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. (C) 2016 by The Society of Thoracic Surgeons
2016
Inglese
epub2015 oct 27
Lorusso, R., Centofanti, P., Gelsomino, S., Barili, F., Di Mauro, M., Orlando, P., Botta, L., Milazzo, F., Actis Dato, G., Casabona, R., Casali, G., Musumeci, F., De Bonis, M., Zangrillo, A., Alfieri, O., Pellegrini, C., Mazzola, S., Coletti, G., Vizzardi, E., Bianco, R., Gerosa, G., Massetti, M., Caldaroni, F., Pilato, E., Pacini, D., Di Bartolomeo, R., Marinelli, G., Sponga, S., Livi, U., Mauro, R., Mariscalco, G., Beghi, C., Miceli, A., Glauber, M., Pappalardo, F., Russo, C. F., Venoarterial Extracorporeal Membrane Oxygenation for Acute Fulminant Myocarditis in Adult Patients: A 5-Year Multi-Institutional Experience, <<ANNALS OF THORACIC SURGERY>>, 2016; 101 (3): 919-926. [doi:10.1016/j.athoracsur.2015.08.014] [http://hdl.handle.net/10807/74432]
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