From the Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
Department of Cardiology, Osaka University Graduate School of Medicine, Osaka, Japan.
ASAIO J. 2023 Jun 1;69(6):561-568. doi: 10.1097/MAT.0000000000001907. Epub 2023 Feb 27.
Fulminant myocarditis (FM) requiring temporary mechanical circulatory support (t-MCS) has a high mortality rate. Peripheral veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and intra-aortic balloon pump (IABP) are sometimes insufficient to induce cardiac recovery. For patients with FM refractory to VA-ECMO with IABP, we have applied a biventricular assist device (BIVAD) or Impella to unload the left ventricle and to fully support the systemic circulation. In the last 10 years, 37 refractory FM patients histologically diagnosed with myocarditis and who did not recover with VA-ECMO were treated with BIVAD (n = 19) or Impella (n = 18). No significant difference was found between the Impella and BIVAD groups in preoperative findings other than serum creatinine level. Seventeen of 18 patients in the Impella group were successfully weaned from t-MCS in 9 (6-12) days. Conversely, the temporary BIVAD was removed in 21 (11-38) days in 10 of 19 patients. Six patients died while on temporary BIVAD because of multiple organ failure and cerebral bleeding, and three patients required conversion to implantable VAD. Compared with BIVAD, left ventricular unloading with Impella could be less invasive and could promote cardiac recovery in refractory FM patients. The Impella has the potential to provide effective temporary MCS for FM patients.
暴发性心肌炎（FM）需要临时机械循环支持（t-MCS），死亡率较高。外周静脉-动脉体外膜肺氧合（VA-ECMO）和主动脉内球囊泵（IABP）有时不足以诱导心脏恢复。对于 FM 患者，VA-ECMO 联合 IABP 无效，我们应用双心室辅助装置（BIVAD）或 Impella 来减轻左心室负荷并充分支持全身循环。在过去 10 年中，我们对 37 例经组织学诊断为心肌炎且 VA-ECMO 治疗无效的难治性 FM 患者应用 BIVAD（n = 19）或 Impella（n = 18）治疗。除血清肌酐水平外，Impella 组和 BIVAD 组在术前发现方面无显著差异。18 例 Impella 组患者中有 17 例在 9（6-12）天内成功脱离 t-MCS。相反，19 例患者中有 10 例 BIVAD 在 21（11-38）天内被移除。6 例患者因多器官衰竭和脑出血而在使用临时 BIVAD 时死亡，3 例患者需要转为植入式 VAD。与 BIVAD 相比，Impella 减轻左心室负荷可能创伤更小，并能促进难治性 FM 患者的心脏恢复。Impella 有可能为 FM 患者提供有效的临时 MCS。
