Issue |
J Extra Corpor Technol
Volume 44, Number 4, December 2012
|
|
---|---|---|
Page(s) | 205 - 209 | |
DOI | https://doi.org/10.1051/ject/201244205 | |
Published online | 15 December 2012 |
Original Articles
The Role of Extracorporeal Life Support in Acute Myocarditis: A Bridge to Recovery?
* Eller Congenital Heart Center, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona
† Mayo Clinic, Scottsdale, Arizona
‡ Phoenix Children’s Hospital, Phoenix, Arizona
Address correspondence to: D. Bradford Sanders, Chief Perfusionist, Cardiothoracic Surgery, Phoenix Children’s Hospital, 1919 E. Thomas Road, Phoenix, AZ 85016. E-mail: dsanders3@phoenixchildrens.com
Received:
17
July
2012
Accepted:
18
October
2012
Acute myocardial failure associated with myocarditis is highly lethal. Left ventricular assist device support for these patients has been advocated to decompress the left ventricle and facilitate myocardial remodeling and recovery. Concerns exist regarding the ability of venoarterial (VA) extracorporeal life support (ECLS) to decompress the left ventricle and allow effective myocardial recovery. ECLS has several advantages, including availability, rapid deployment, and flexibility, as compared with contemporary ventricular assist devices. The objective of this study was to provide a brief review of acute myocarditis and present our series of patients. After Institutional Review Board approval, we conducted a retrospective data analysis of patients on ECLS experiencing rapidly progressive myocardial failure from a normal baseline. Patients with a history of intrinsic heart disease were excluded. All patients were thought to have myocarditis and had failed medical therapy requiring emergent ECLS support. Five patients demographics are detailed in Table 1. Patients experienced life-threatening intractable dysrhythmias or cardiac arrest and were refractory to medical therapy with severe acidosis and impending multisystem organ failure. All patients were stabilized with VA ECLS, and the left ventricle and atrium were decompressed in four of five patients. A left atrial vent was placed in one patient. Myocardial recovery with successful weaning from ECLS was obtained in four of five patients and to a normal ejection fraction in three of the five. One patient failed ECLS weaning and required biventricular VAD support secondary to severe myocardial necrosis from giant cell myocarditis and was transplanted, one died, all others are alive at follow-up. ECLS is safe and effective to treat acute myocardial failure and may be used to obtain myocardial recovery in certain subsets. We devised a decision algorithm for ECLS deployment in this patient cohort and routinely use ECLS.
Key words: ECLS / LVAD / acute myocardial failure / myocardial recovery
© 2012 AMSECT
Current usage metrics show cumulative count of Article Views (full-text article views including HTML views, PDF and ePub downloads, according to the available data) and Abstracts Views on Vision4Press platform.
Data correspond to usage on the plateform after 2015. The current usage metrics is available 48-96 hours after online publication and is updated daily on week days.
Initial download of the metrics may take a while.