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

• Published in: The Annals of thoracic surgery Vol. 101; no. 3; pp. 919 - 926
• Main Authors: Lorusso, Roberto, MD, PhD, Centofanti, Paolo, MD, Gelsomino, Sandro, MD, PhD, Barili, Fabio, MD, PhD, Di Mauro, Michele, MD, Orlando, Parise, MS, Botta, Luca, MD, Milazzo, Filippo, MD, Actis Dato, Guglielmo, MD, Casabona, Riccardo, MD, Casali, Giovanni, MD, Musumeci, Francesco, MD, De Bonis, Michele, MD, Zangrillo, Alberto, MD, Alfieri, Ottavio, MD, Pellegrini, Carlo, MD, Mazzola, Sandro, MD, Coletti, Giuseppe, MD, Vizzardi, Enrico, MD, Bianco, Roberto, MD, Gerosa, Gino, MD, Massetti, Massimo, MD, PhD, Caldaroni, Federica, MD, Pilato, Emanuele, MD, Pacini, Davide, MD, Di Bartolomeo, Roberto, MD, Marinelli, Giuseppe, MD, Sponga, Sandro, MD, PhD, Livi, Ugolino, MD, Mauro, Rinaldi, MD, Mariscalco, Giovanni, MD, PhD, Beghi, Cesare, MD, Miceli, Antonio, MD, PhD, Glauber, Mattia, MD, Pappalardo, Federico, MD, Russo, Claudio Francesco, MD
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01-03-2016
• Subjects: Acute Disease; Adult; Cardiothoracic Surgery; Extracorporeal Membrane Oxygenation - methods; Female; Follow-Up Studies; Humans; Italy - epidemiology; Male; Myocarditis - mortality; Myocarditis - surgery; Postoperative Complications - epidemiology; Retrospective Studies; Surgery; Survival Rate - trends; Time Factors; Treatment Outcome; Italy
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2015.08.014

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.