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  • Title: Paracorporeal pulsatile biventricular assist device versus extracorporal membrane oxygenation-extracorporal life support in adult fulminant myocarditis.
    Author: Pages ON, Aubert S, Combes A, Luyt CE, Pavie A, Léger P, Gandjbakhch I, Leprince P.
    Journal: J Thorac Cardiovasc Surg; 2009 Jan; 137(1):194-7. PubMed ID: 19154925.
    Abstract:
    OBJECTIVE: Biventricular assist device support with a paracorporeal pulsatile device is known to be an efficient bridge to recovery for patients with fulminant myocarditis-related cardiogenic shock. Whether these patients can be as efficiently supported with femorofemoral extracorporeal membrane oxygenation remains unclear. METHODS: From 2001 to 2006, 11 patients were referred to our cardiac surgery department for fulminant myocarditis-related cardiogenic shock. The first 5 patients (mean age, 32 +/- 2 years) were supported with a biventricular assist device (Thoratec, Pleasanton, Calif; group I), whereas the remaining patients (40 +/- 4 years) were supported with femorofemoral extracorporeal membrane oxygenation (group II). Preimplantation probability of death was calculated by using the APACHE II score, which was 11 +/- 9 in group I versus 24 +/- 18 in group II. RESULTS: One patient in each group died while receiving support. In group I the death occurred after 18 days of support in a patient who had 45 minutes of external resuscitation before biventricular assist device implantation. In group II a patient who remained unstable during extracorporeal membrane oxygenation was switched to a biventricular assist device 13 days later and eventually died of tamponade after 45 days. All other patients were weaned from the device after a mean duration of support of 21 +/- 5 days in group I versus 13 +/- 4 days in group II. At hospital discharge, the mean ejection fraction was 45% +/- 5% in both groups, and at 6 months' follow-up, it was 65% and 75%, respectively, in groups I and II. CONCLUSION: In our experience extracorporeal membrane oxygenation is as efficient as use of a biventricular assist device as a bridge to recovery for patients with fulminant myocarditis-related cardiogenic shock and facilitates renal and hepatic recovery on support.
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