Journal of Artificial Organs

, Volume 21, Issue 2, pp 172–179 | Cite as

Diagnosis, medical treatment, and stepwise mechanical circulatory support for fulminat myocarditis

  • Shunsuke Saito
  • Koichi Toda
  • Shigeru Miyagawa
  • Yasushi Yoshikawa
  • Hiroki Hata
  • Daisuke Yoshioka
  • Keitaro Domae
  • Yasumasa Tsukamoto
  • Yasushi Sakata
  • Yoshiki Sawa
Original Article Artificial Heart (Clinical)

Abstract

Fulminant myocarditis is one of the most challenging diseases. We sought to examine the outcomes of our multidisciplinary treatment strategy for fulminant myocarditis. A retrospective review of consecutive 30 patients with fulminant myocarditis was conducted. Of the 30 patients, 25 required mechanical circulatory support (MCS). Percutaneous extracorporeal membrane oxygenation (ECMO) was the first-line therapy to rescue the patients and inserted in 23 of them. The other 2 were implanted with temporary ventricular assist device (t-VAD) with extracorporeal centrifugal pump(s). Sixteen of the ECMO-supported patients were later transitioned to t-VAD. Of the 18 patients who underwent t-VAD support, heart function recovered and the VAD was explanted in 10. Four patients were bridged to long-term VAD and the other 4 died on t-VAD. Two patients were directly bridged to long-term VAD by ECMO. Heart function recovered only with ECMO in 4 patients and 1 died on ECMO. Overall survival rate was 83.3%. The duration of ECMO support significantly correlated with total bilirubin level, which was a significant risk factor for mortality. Pathologically, 7 patients (23.3%) had eosinophilic myocarditis and 1 (3.3%) had giant-cell myocarditis, and all the 8 patients underwent immunosuppressive therapy including steroids. Heart function recovered to normal level in 7 of them (87.5%). Timely conversion from the percutaneous ECMO to the temporary VAD before elevation of total bilirubin level is crucial for improving the clinical outcomes. Endomyocardial biopsy is needed to be done as soon as possible, because immunosuppressive therapy carries promising outcomes in certain etiologies.

Keywords

Fulminant myocarditis Extracorporeal membrane oxygenation Temporary left ventricular assist device Endomyocardial biopsy 

Notes

Compliance with ethical standards

Conflict of interest

All authors declare no conflict of interest associated with this study.

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Copyright information

© The Japanese Society for Artificial Organs 2017

Authors and Affiliations

  • Shunsuke Saito
    • 1
  • Koichi Toda
    • 1
  • Shigeru Miyagawa
    • 1
  • Yasushi Yoshikawa
    • 1
  • Hiroki Hata
    • 1
  • Daisuke Yoshioka
    • 1
  • Keitaro Domae
    • 1
  • Yasumasa Tsukamoto
    • 2
  • Yasushi Sakata
    • 2
  • Yoshiki Sawa
    • 1
  1. 1.Department of Cardiovascular SurgeryOsaka University Graduate School of MedicineSuitaJapan
  2. 2.Department of Cardiovascular MedicineOsaka University Graduate School of MedicineSuitaJapan

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