Fulminant giant-cell myocarditis on mechanical circulatory support: Management and outcomes of a French multicentre cohort
Por:
Montero, S, Aissaoui, N, Tadie, JM, Bizouarn, P, Scherrer, V, Persichini, R, Delmas, C, Rolle, F, Besnier, E, Le Guyader, A, Combes, A, Schmidt, M
Publicada:
15 feb 2018
Resumen:
Aims: Giant-cell myocarditis (GCM) is a rare and often fatal form of myocarditis. Only a few reports have focused on fulminant forms. We describe the clinical characteristics, management and outcomes of GCM patients rescued by mechanical circulatory support (MCS).
Methods and results: The clinical features, diagnoses, treatments and outcomes of MCS-treated patients in refractory cardiogenic shock secondary to fulminant GCM admitted to eight French intensive care units (2002-2016) were analysed. We also conducted a systematic review of this topic. Thirteen patients (median age 44 [range 21-76] years, Simplified Acute Physiology Score II55 [40-79]) in severe cardiogenic shock (median [range] left ventricular ejection fraction 15% [15-35%] and blood lactate 4 mmol/L) were placed on MCS 4 [0-28] days after hospital admission. Severe arrhythmic disturbances were frequent (77%), with six (46%) patients experiencing an electrical storm prior to MCS. Venoarterial extracorporeal membrane oxygenation was the first MCS option for 11 (85%) patients. GCM was diagnosed in five (38%) patients before transplant or death and treated with immunosuppressants; infections were the main complication (80%). Four patients died on MCS and no patient presented long-term survival free from heart transplant (nine patients, 69%). All transplanted patients were alive 1 year later and no GCM recurrence was reported after median follow-up of 42 [12-145] months.
Conclusion: Outcomes of fulminant GCMs may differ from those of milder forms. In this context, heart transplant might likely be the only long-term survival option. (c) 2017 Elsevier B.V. All rights reserved.
Filiaciones:
Montero, S:
Hop La Pitie Salpetriere, AP HP, Inst Cardiometab & Nutr, Med Intens Care Unit,iCAN, Paris, France
Hosp Santa Creu & Sant Pau, Biomed Res Inst IIB St Pau, Dept Cardiol, Acute & Intens Cardiovasc Care Unit, Barcelona, Spain
Aissaoui, N:
Paris Descartes Univ, European Georges Pompidou Hosp, Intens Care Unit, U970, Paris, France
Tadie, JM:
Pontchaillou Univ Hosp, Infect Dis & Intens Care Unit, Rennes, France
Bizouarn, P:
CHU Nantes, Cardiac Intens Care Dept, Nantes, France
Scherrer, V:
Rouen Univ Hosp, Dept Anaesthesiol & Crit Care, Rouen, France
Persichini, R:
CHU La Reunion, Felix Guyon Hosp, Med Surg Intens Care Unit, St Denis, La Reunion, France
Delmas, C:
Hop Rangueil, Med Intens Care Unit, Toulouse, France
Rolle, F:
CHU Limoges, Thorac & Cardiac Surg Dept, Limoges, France
Besnier, E:
Rouen Univ Hosp, Dept Anaesthesiol & Crit Care, Rouen, France
Le Guyader, A:
CHU Limoges, Thorac & Cardiac Surg Dept, Limoges, France
Combes, A:
Hop La Pitie Salpetriere, AP HP, Inst Cardiometab & Nutr, Med Intens Care Unit,iCAN, Paris, France
Schmidt, M:
Hop La Pitie Salpetriere, AP HP, Inst Cardiometab & Nutr, Med Intens Care Unit,iCAN, Paris, France
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