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
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