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

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• 作者：Roberto Lorusso ; MD ; PhD^a ; ^{roberto.lorussobs@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Paolo Centofanti ; MD^b ; Sandro Gelsomino ; MD ; PhD^c ; Fabio Barili ; MD ; PhD^d ; Michele Di Mauro ; MD^e ; Parise Orlando ; MS^c ; Luca Botta ; MD^f ; Filippo Milazzo ; MD^f ; Guglielmo Actis Dato ; MD^g ; Riccardo Casabona ; MD^g ; Giovanni Casali ; MD^h ; Francesco Musumeci ; MD^h ; Michele De Bonis ; MDⁱ ; Alberto Zangrillo ; MDⁱ ; Ottavio Alfieri ; MDⁱ ; Carlo Pellegrini ; MD^k ; Sandro Mazzola ; MD^k ; Giuseppe Coletti ; MD^a ; Enrico Vizzardi ; MD^j ; Roberto Bianco ; MD^l ; Gino Gerosa ; MD^l ; Massimo Massetti ; MD ; PhD^m ; Federica Caldaroni ; MD^m ; Emanuele Pilato ; MDⁿ ; Davide Pacini ; MDⁿ ; Roberto Di Bartolomeo ; MDⁿ ; Giuseppe Marinelli ; MDⁿ ; Sandro Sponga ; MD ; PhD^o ; Ugolino Livi ; MD^o ; Rinaldi Mauro ; MD^b ; Giovanni Mariscalco ; MD ; PhD^r ; Cesare Beghi ; MD^p ; Antonio Miceli ; MD ; PhD^q ; Mattia Glauber ; MD^q ; Federico Pappalardo ; MDⁱ ; Claudio Francesco Russo ; MD^f ; on behalf of the GIROC Investigators
• 刊名：The Annals of Thoracic Surgery
• 出版年：2016
• 出版时间：March 2016
• 年：2016
• 卷：101
• 期：3
• 页码：919-926
• 全文大小：182 K

文摘

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.