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DOI: 10.1055/s-2007-967570
Bridge to recovery by mechanical ventricular assist (VAD) – a successful therapy for cardiac failure due to acute fulminant myocarditis
Aims: Acute fulminant myocarditis can lead to cardiac failure refractory to medical therapy. Those often young patients are deathbound, unless any form of circulatory assist is installed mostly on an emergency basis. We report about our experience in such a group.
Patients: Between January 2002 and July 2005 3 pediatric (age 7.5±6 years) and 5 adult patients (age 30.4±7.6 years) were transferred to our center with acute onset, progressive cardiac failure refractory to medical therapy and suspicion of acute myocarditis. LV ejection fraction was <10% in all patients despite maximal inotropic support. 3 required cardio-pulmonary resuscitation prior to assist implantation. All children received percutaneous ECMO via jugular vein /carotid artery or femoral vein / artery, 2 of them received additional interventional atrial septostomy (ASD) for biatrial unloading. In the adult group 3 patients received biventricular VAD via sternotomy, 1 a peripheral femoral veno-arterial ECMO plus intraaortic ballon pump (IABP) and another one IABP only. In 4/8 endo-/epicardial biopsy was performed to confirm diagnosis.
Results: There was no surgical complication in any patient, average bridging time was 16.5±10.4 days. All survivors were off ß-adrenergic support within 1.5±3.6 days. Overall survival was 75% (6/8) with sustained myocardial recovery in all survivors of up to 1.5±1.8 years follow-up. One survivor sufferes from sustained neurological damage due to preoperative laymen resuscitation.
Conclusion: Installation of mechanical assist devices is a successful treatment as bridge to recovery for acute myocarditic failure. Sufficient myocardial unloading for early weaning of ß-adrenergic support seems crucial for myocardial recovery