Sanders D Bradford, Sowell Steven R, Willis Brigham, Lane John, Pierce Christopher, Pophal Stephen, Arabia Francisco A, Nigro John J
Eller Congenital Heart Center, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
J Extra Corpor Technol. 2012 Dec;44(4):205-9.
Acute myocardial failure associated with myocarditis is highly lethal. Left ventricular assist device support for these patients has been advocated to decompress the left ventricle and facilitate myocardial remodeling and recovery. Concerns exist regarding the ability of venoarterial (VA) extracorporeal life support (ECLS) to decompress the left ventricle and allow effective myocardial recovery. ECLS has several advantages, including availability, rapid deployment, and flexibility, as compared with contemporary ventricular assist devices. The objective of this study was to provide a brief review of acute myocarditis and present our series of patients. After Institutional Review Board approval, we conducted a retrospective data analysis of patients on ECLS experiencing rapidly progressive myocardial failure from a normal baseline. Patients with a history of intrinsic heart disease were excluded. All patients were thought to have myocarditis and had failed medical therapy requiring emergent ECLS support. Five patients demographics are detailed in Table 1. Patients experienced life-threatening intractable dysrhythmias or cardiac arrest and were refractory to medical therapy with severe acidosis and impending multisystem organ failure. All patients were stabilized with VA ECLS, and the left ventricle and atrium were decompressed in four of five patients. A left atrial vent was placed in one patient. Myocardial recovery with successful weaning from ECLS was obtained in four of five patients and to a normal ejection fraction in three of the five. One patient failed ECLS weaning and required biventricular VAD support secondary to severe myocardial necrosis from giant cell myocarditis and was transplanted, one died, all others are alive at follow-up. ECLS is safe and effective to treat acute myocardial failure and may be used to obtain myocardial recovery in certain subsets. We devised a decision algorithm for ECLS deployment in this patient cohort and routinely use ECLS.
与心肌炎相关的急性心肌衰竭具有高度致死性。对于这些患者，提倡使用左心室辅助装置来减轻左心室负荷，促进心肌重塑和恢复。对于静脉 - 动脉（VA）体外生命支持（ECLS）减轻左心室负荷并实现有效心肌恢复的能力存在担忧。与当代心室辅助装置相比，ECLS具有几个优点，包括可用性、快速部署和灵活性。本研究的目的是简要回顾急性心肌炎并展示我们的患者系列。经机构审查委员会批准后，我们对基线正常但因快速进展性心肌衰竭接受ECLS治疗的患者进行了回顾性数据分析。排除有先天性心脏病史的患者。所有患者均被认为患有心肌炎且药物治疗失败，需要紧急ECLS支持。表1详细列出了5例患者的人口统计学数据。患者经历了危及生命的顽固性心律失常或心脏骤停，对药物治疗无效，伴有严重酸中毒和即将发生的多系统器官衰竭。所有患者均通过VA - ECLS稳定病情，5例患者中有4例左心室和心房减压。1例患者放置了左心房引流管。5例患者中有4例实现了心肌恢复并成功脱离ECLS，5例中有3例射血分数恢复正常。1例患者脱离ECLS失败，因巨细胞心肌炎导致严重心肌坏死需要双心室VAD支持并接受了移植，1例死亡，其他所有患者在随访时均存活。ECLS治疗急性心肌衰竭安全有效，可用于某些亚组患者实现心肌恢复。我们为该患者队列设计了ECLS部署的决策算法，并常规使用ECLS。
