From the Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
Department of Surgery, The University of Alabama at Birmingham, Birmingham, Alabama.
ASAIO J. 2022 Feb 1;68(2):190-196. doi: 10.1097/MAT.0000000000001430.
Myocarditis can be refractory to medical therapy and require durable mechanical circulatory support (MCS). The characteristics and outcomes of these patients are not known. We identified all patients with clinically-diagnosed or pathology-proven myocarditis who underwent mechanical circulatory support in the International Society for Heart and Lung Transplantation Registry for Mechanically Assisted Circulatory Support registry (2013-2016). The characteristics and outcomes of these patients were compared to those of patients with nonischemic cardiomyopathy (NICM). Out of 14,062 patients in the registry, 180 (1.2%) had myocarditis and 6,602 (46.9%) had NICM. Among patients with myocarditis, duration of heart failure was <1 month in 22%, 1-12 months in 22.6%, and >1 year in 55.4%. Compared with NICM, patients with myocarditis were younger (45 vs. 52 years, P < 0.001) and were more often implanted with Interagency Registry for Mechanically Assisted Circulatory Support profile 1 (30% vs. 15%, P < 0.001). Biventricular mechanical support (biventricular ventricular assist device [BIVAD] or total artificial heart) was implanted more frequently in myocarditis (18% vs. 6.7%, P < 0.001). Overall postimplant survival was not different between myocarditis and NICM (left ventricular assist device: P = 0.27, BIVAD: P = 0.50). The proportion of myocarditis patients that have recovered by 12 months postimplant was significantly higher in myocarditis compared to that of NICM (5% vs. 1.7%, P = 0.0003). Adverse events (bleeding, infection, and neurologic dysfunction) were all lower in the myocarditis than NICM. In conclusion, although myocarditis patients who receive durable MCS are sicker preoperatively with higher needs for biventricular MCS, their overall MCS survival is noninferior to NICM. Patients who received MCS for myocarditis are more likely than NICM to have MCS explanted due to recovery, however, the absolute rates of recovery were low.
心肌炎可能对药物治疗有抗性，需要长期的机械循环支持 (MCS)。目前还不了解这些患者的特征和结局。我们在国际心肺移植协会机械循环支持登记处 (2013-2016 年) 中确定了所有接受机械循环支持治疗的临床诊断或病理证实为心肌炎的患者。将这些患者的特征和结局与非缺血性心肌病 (NICM) 患者进行了比较。在登记处的 14062 名患者中，有 180 名 (1.2%) 患有心肌炎，6602 名 (46.9%) 患有 NICM。在心肌炎患者中，心力衰竭持续时间 <1 个月的占 22%，1-12 个月的占 22.6%，>1 年的占 55.4%。与 NICM 相比，心肌炎患者更年轻 (45 岁 vs. 52 岁，P < 0.001)，植入 Interagency Registry for Mechanically Assisted Circulatory Support 1 型的比例更高 (30% vs. 15%，P < 0.001)。双心室机械支持 (双心室心室辅助装置 [BIVAD] 或全人工心脏) 在心肌炎中更为常见 (18% vs. 6.7%，P < 0.001)。心肌炎和 NICM 的植入后总体存活率无差异 (左心室辅助装置：P = 0.27，BIVAD：P = 0.50)。植入后 12 个月，心肌炎患者的恢复比例显著高于 NICM (5% vs. 1.7%，P = 0.0003)。与 NICM 相比，心肌炎患者的不良事件 (出血、感染和神经功能障碍) 均较低。总之，尽管接受长期 MCS 的心肌炎患者术前病情更重，需要双心室 MCS 的可能性更高，但他们的整体 MCS 存活率并不劣于 NICM。然而，由于恢复而接受 MCS 治疗的心肌炎患者比 NICM 更有可能被移除 MCS，但恢复的绝对比例较低。
