Kardiochirurgia dorosłych
Polish ventricular assist device (POLVAD) support for the treatment of cardiogenic shock in patients with myocarditis

Paweł Litwiński

,

Bogdan Woźniewicz

,

Grzegorz Religa

,

Małgorzata Pastuszek

,

Adam Parulski

,

Małgorzata Jasińska

,

Szymon Kocańda

,

Roman Kustosz

,

Piotr Siondalski

,

Zbigniew Religa

Background: Myocarditis is a disease of variable clinical expression that ranges from the asymptomatic state associated with limited and focal inflammation to fulminant fatal congestive heart failure due to diffuse involvement of the myocardium In cases with severe haemodynamic decompensation mechanical circulatory support may serve as a bridge to myocardial recovery or transplantation Aim: A review of the efficacy of ventricular assist device applications for the treatment of cardiogenic shock in patients with myocarditis Material and methods: A retrospective review of 11 patients (6 female, 5 male) with myocarditis supported with Polish Ventricular Assist Devices (POLVAD) between November 1999 and December 2004 in 3 institutions was performed Most of the patients had histories and clinical findings consistent with acute/fulminant myocarditis and had a rapidly progressive course of clinical deterioration that resulted in refractory cardiorespiratory failure/cardiogenic shock despite maximal medical therapy and IABP support (100%) The median age was 21 years (range 15-34 years) with a median duration of mechanical circulatory support of 30 days (range 5-53 days) During this time, the patients underwent repetitive echocardiography to asses the presentation and potential for cardiac recovery All the patients were supported by biventricular assist devises (BiVAD) Results: Five patients (455%) recovered and were weaned from support and 4 (80%) were discharged Four (364%) were successfully bridged to transplantation, with 3 (75%) survivors that were discharged Overall survival was 636% (7 from 11 patients) Six of seven survivors are currently alive Conclusion: Although acute fulminant myocarditis can be rapidly fatal, it has been shown that the heart can recover in some patients if the circulation is supported Because of this fact and the option of cardiac transplantation for those whose ventricular function does not improve, aggressive measures to support these patients during the acute phase of disease seem to be justified, with survival rates of 50-70% that have been demonstrated with pulsatile support