The Role of Extracorporeal Life Support in Acute Myocarditis: A Bridge to Recovery?
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.
