Outcomes of Mechanical Circulatory Support for Giant Cell Myocarditis: A Systematic Review
| Autor: | Vakhtang Tchantchaleishvili, Preethi Pirlamarla, Thomas J. O’Malley, J. Eduardo Rame, Elizabeth J. Maynes, John W. Entwistle, Leslie T. Cooper, H. Todd Massey, Rene Alvarez, Abhiraj Saxena, Chelsey T. Wood, Preeyal M. Patel |
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| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Myocarditis
medicine.medical_treatment lcsh:Medicine 030204 cardiovascular system & hematology Giant cell myocarditis survival Article 03 medical and health sciences 0302 clinical medicine Interquartile range medicine 030212 general & internal medicine Heart transplantation mechanical circulatory support immunosuppression treatment business.industry Cardiogenic shock lcsh:R Immunosuppression General Medicine medicine.disease humanities Heart failure Anesthesia Circulatory system myocarditis business |
| Zdroj: | Journal of Clinical Medicine, Vol 9, Iss 3905, p 3905 (2020) Journal of Clinical Medicine Volume 9 Issue 12 |
| ISSN: | 2077-0383 |
| Popis: | Treatment of giant cell myocarditis (GCM) can require bridging to orthotopic heart transplantation (OHT) or recovery with mechanical circulatory support (MCS). Since the roles of MCS and immunotherapy are not well-defined in GCM, we sought to analyze outcomes of patients with GCM who required MCS. A systematic search was performed in June 2019 to identify all studies of biopsy-proven GCM requiring MCS after 2009. We identified 27 studies with 43 patients. Patient-level data were extracted for analysis. Median patient age was 45 (interquartile range (IQR): 32&ndash 57) years. 42.1% (16/38) were female. 34.9% (15/43) presented in acute heart failure. 20.9% (9/43) presented in cardiogenic shock. Biventricular (BiVAD) MCS was required in 76.7% (33/43) of cases. Of the 62.8% (27/43) of patients who received immunotherapy, 81.5% (22/27) used steroids combined with at least one other immunosuppressant. Cyclosporine was the most common non-steroidal agent, used in 40.7% (11/27) of regimens. Immunosuppression was initiated before MCS in 59.3% (16/27) of cases, after MCS in 29.6% (8/27), and not specified in 11.1% (3/27). Immunosuppression started prior to MCS was associated with significantly better survival than MCS alone (p = 0.006) 60.5% (26/43) of patients received bridge-to-transplant MCS 39.5% (17/43) received bridge-to-recovery MCS 58.5% (24/41) underwent OHT a median of 104 (58&ndash 255) days from diagnosis. GCM recurrence after OHT was reported in 8.3% (2/24) of transplanted cases. BiVAD predominates in mechanically supported patients with GCM. Survival and bridge to recovery appear better in patients on immunosuppression, especially if initiated before MCS. |
| Databáze: | OpenAIRE |
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