Improved survival in patients with acute myocarditis using external pulsatile mechanical ventricular assistance
Autor: | Kelly A Tector, Mehmet C. Oz, Jonathan M. Chen, Daniel Marelli, Suzanne Cullinane, M. Flannery, John J Gonzalez, Talia B. Spanier |
---|---|
Rok vydání: | 1999 |
Předmět: |
Male
medicine.medical_treatment Embolism Cardiac index Blood Pressure Blood Urea Nitrogen Cohort Studies Registries Renal Insufficiency Cardiac Output Ejection fraction Central venous pressure Alanine Transaminase Middle Aged Survival Rate Myocarditis Treatment Outcome Creatinine Pulsatile Flow Acute Disease Cardiology Female Cardiology and Cardiovascular Medicine Respiratory Insufficiency Pulmonary and Respiratory Medicine Adult Reoperation medicine.medical_specialty Adolescent Central Venous Pressure Postoperative Hemorrhage Internal medicine medicine Humans Surgical Wound Infection Aspartate Aminotransferases Pulmonary Wedge Pressure Pulmonary wedge pressure Retrospective Studies Transplantation business.industry Stroke Volume medicine.disease Ventricular assist device Heart failure Surgery Heart-Assist Devices business Follow-Up Studies |
Zdroj: | The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation. 18(4) |
ISSN: | 1053-2498 |
Popis: | Background: Acute myocarditis remains a disease with a variable clinical course, from full ventricular recovery to complete heart failure; to date, few cases have been reported that describe the efficacy of temporary mechanical ventricular assistance for its treatment. Methods We evaluated the voluntary world registry with the use of an external pulsatile ventricular assist device (the ABIOMED BVS 5000 [BVS]) for acute myocarditis to determine the impact of mechanical ventricular assistance on outcome. Variables analyzed included patient demographics, serum chemistries, and overall hemodynamics prior to BVS, while on BVS support, and after BVS explanation. Postoperative parameters included re-operation, bleeding, respiratory failure, renal failure, and infections, neurologic, or embolic events. Results Eighteen patients in the ABIOMED world registry underwent BVS implantation for myocarditis; 11 (61.1%) had complete pre-operative and hemodynamic data for analysis. Patients were supported for 13.2 ± 17.0 days, after which time 7 (63.6%) patients survived to explanation of the device and 2 (18.2%) underwent transplantation. Elevated admission serum chemistries (blood ureanitrogen [BUN], creatinine, transaminases) and hemodynamics (central venous pressure [CVP], mean pulmonary arterial pressure [PAP], pulmonary capillary wedge pressure [PCW], cardiac index [CI], all normalized during the period of device support. Estimated ejection fractions in the 7 explanted patients ranged between 50 to 60% at routine evaluation 3 years after device removal. Conclusions Temporary mechanical ventricular assistance represents an efficacious therapy for acute myocarditis in patients with hemodynamic decompensation despite maximal medical therapy. Failure to achieve full ventricular recovery while on device support still allows for other surgical alternatives, including implantation of a long-term implantable ventricular assist device, or cardiac transplantation. |
Databáze: | OpenAIRE |
Externí odkaz: |