Dogan Günes, Hanke Jasmin, Puntigam Jakob, Haverich Axel, Schmitto Jan D
Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
Int J Artif Organs. 2018 Aug;41(8):474-479. doi: 10.1177/0391398818777362. Epub 2018 May 30.
Giant-cell myocarditis represents a rare and often fatal autoimmune disorder. Despite extracorporeal life support being a valid treatment option, alternatives to control the underlying inflammatory response remain sparse. A new hemoadsorption device (CytoSorb) has recently been introduced to treat patients with an excessive inflammatory response.
A 57-year-old patient developed fulminant right heart failure, respiratory insufficiency, hemodynamic instability, and oliguric-anuric renal failure. An extracorporeal life support together with an Impella was implanted for circulatory support. Due to non-pulsatility, acontractility of the left ventricle and a heavily reduced right ventricular function, a left ventricular assist device implantation and change from extracorporeal life support to veno-pulmonary arterial extracorporeal membrane oxygenation was performed. Since adequate hemodynamic stabilization could not be achieved and due to increasing inflammatory mediators and bilirubin levels, the decision was made to additionally integrate a CytoSorb hemoadsorber into the system.
The combined treatment resulted in a clear and steady improvement in hemodynamics and the inflammatory condition with marked reductions in all measured parameters throughout the treatment period. Metabolic acidosis resolved and liver function improved.
Extracorporeal life support therapy represents a bridging approach to heart transplantation or to cardiac recovery and can be complemented by CytoSorb as an independent therapeutic option. The patient described herein with giant-cell myocarditis and fulminant cardiac failure who received substantial extracorporeal support in combination with CytoSorb hemoadsorption therapy benefited in terms of an improvement of organ function and his inflammatory situation.
巨细胞性心肌炎是一种罕见且通常致命的自身免疫性疾病。尽管体外生命支持是一种有效的治疗选择，但控制潜在炎症反应的替代方法仍然很少。最近引入了一种新的血液吸附装置（CytoSorb）来治疗炎症反应过度的患者。
一名57岁患者出现暴发性右心衰竭、呼吸功能不全、血流动力学不稳定和少尿-无尿性肾衰竭。植入体外生命支持装置并联合Impella进行循环支持。由于左心室无搏动性、收缩功能丧失以及右心室功能严重减退，进行了左心室辅助装置植入，并将体外生命支持改为静脉-肺动脉体外膜肺氧合。由于未能实现充分的血流动力学稳定，且炎症介质和胆红素水平不断升高，决定在系统中额外加入CytoSorb血液吸附器。
联合治疗使血流动力学和炎症状况明显且稳定地改善，在整个治疗期间所有测量参数均显著降低。代谢性酸中毒得到缓解，肝功能得到改善。
体外生命支持疗法是心脏移植或心脏恢复的一种过渡方法，可通过CytoSorb作为一种独立的治疗选择进行补充。本文所述的患有巨细胞性心肌炎和暴发性心力衰竭的患者，接受了大量体外支持并联合CytoSorb血液吸附疗法，在器官功能和炎症状况改善方面获益。
