Efficacy of central extracorporeal life support for patients with fulminant myocarditis and cardiogenic shock. (25th June 2021)

• Record Type: Journal Article
• Authors: Tadokoro, Naoki; Fukushima, Satsuki; Minami, Kimito; Taguchi, Takura; Saito, Tetsuya; Kawamoto, Naonori; Kakuta, Takashi; Seguchi, Osamu; Watanabe, Takuya; Nakajima Doi, Seiko; Kuroda, Kensuke; Suzuki, Keisuke; Yanase, Masanobu; Asaumi, Yasuhide; Shimizu, Hideyuki; Fukushima, Norihide; Fujita, Tomoyuki
• Is Part Of: European journal of cardio-thoracic surgery. Volume 60:Number 5(2021)
• Page Start: 1184
• Page End: 1192
• Publication Date: 2021-06-25
• Subjects: Fulminant myocarditis -- Mechanical circulatory support -- Extracorporeal life support -- Ventricular assist device -- Creatine kinase-MB -- Rhythm disturbance; Heart -- Surgery -- Periodicals; Chest -- Surgery -- Periodicals; 617.54
• DOI: 10.1093/ejcts/ezab231
• Languages: English
• ISSNs: 1010-7940

Abstract

Abstract: : OBJECTIVES: Fulminant myocarditis with cardiogenic shock requires extracorporeal life support (ECLS) and has poor outcomes. To improve outcomes, we have converted patients with severely impaired cardiac and multiorgan function from peripheral to central ECLS. In this study, we reviewed these patients' clinical outcomes and investigated associated factors. METHODS: We retrospectively studied 70 consecutive patients with fulminant myocarditis under peripheral support from 2006 to 2020. Forty-eight patients underwent surgical conversion to central support, and the remaining patients continued peripheral support. The end point was survival and ventricular assist device-free survival. RESULTS: More severe pulmonary congestion and multiorgan failure were present in patients with central than peripheral support. Weaning from ECLS was achieved in 95% and 62% of patients with peripheral and central support, respectively. Five-year survival was not significantly different between patients with central and peripheral support (71.2% vs 87.5%, respectively; P = 0.15). However, the ventricular assist device-free survival rate was significantly higher in patients with central than peripheral support (82.2% vs 52.0%, respectively; P = 0.017). A peak creatine kinase-MB level of >180 IU/l, rhythm disturbance and aortic valve closure were detrimental to functional recovery in patients with central support. CONCLUSIONS: Conversion to central ECLS is feasible and safe in patients with fulminant myocarditis. Patients with severe myocardial injury as shown by a high creatine kinase-MB level, rhythm disturbance and aortic valve closure should be converted to a durable left ventricular assist device.