Venoarterial extracorporeal membrane oxygenation for acute fulminant myocarditis in adult patients: A 5-year multi-institutional experience

Roberto Lorusso, Paolo Centofanti, Sandro Gelsomino, Fabio Barili, Michele Di Mauro, Parise Orlando, Luca Botta, Filippo Milazzo, Guglielmo Actis Dato, R. Casabona, Giovanni Casali, Francesco Musumeci, Michele De Bonis, Alberto Zangrillo, Ottavio Alfieri, Carlo Pellegrini, Sandro Mazzola, Giuseppe Coletti, Enrico Vizzardi, Roberto BiancoGino Gerosa, Massimo Massetti, Federica Caldaroni, Emanuele Pilato, Davide Pacini, Roberto Di Bartolomeo, Giuseppi Marinelli, Sandro Sponga, Ugolino Livi, Rinaldi Mauro, Giovanni Mariscalco, Cesare Beghi, Antonio Miceli, Mattia Glauber, Federico Pappalardo, Claudio F. Russo

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish
Pages (from-to)919-926
Number of pages8
JournalAnnals of Thoracic Surgery
Volume101
Issue number3
DOIs
Publication statusPublished - Mar 1 2016

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

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