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Venoarterial extracorporeal membrane oxygenation support for acute fulminant myocarditis - a single-center experience
Session:
Posters - E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Speaker:
Lisa Maria Ferraz
Congress:
CPC 2021
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
14. Acute Cardiac Care
Subtheme:
14.3 Acute Cardiac Care – CCU, Intensive, and Critical Cardiovascular Care
Session Type:
Posters
FP Number:
---
Authors:
Lisa Maria Ferraz; Catarina Costa; Rita Ferreira; Ana Faustino; Roberto Roncon Albuquerque; José Artur Paiva; Ana Neves
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Introduction: Acute f<span style="background-color:white"><span style="color:black">ulminant myocarditis (AFM) may be life threatening. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) can provide an effective cardiocirculatory support.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Purpose: This study aims to evaluate the clinical course and the prognosis of patients (P) with fulminant myocarditis supported by VA-ECMO.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Methods: Observational retrospective single-center study of 15 consecutive P (73% women; 45,6±11,6 years; body mass index 26,7±2,23kg/m<sup>2</sup>) admitted to an intensive care unit (ICU) for AFM managed by peripheral VA-ECMO between 2008 and 2018. Were included P with diagnosis of myocarditis, recent onset of symptoms and severe hemodynamic compromise within 7 days following hospital admission. P were followed during 29,4±8,4 months after discharge to identify rehospitalization due to cardiovascular causes (re-hosp), recurrence of myocarditis or death.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Results: The P had previous history of hypertension (20%), diabetes (13%), dyslipidemia (20%), autoimmune disease (7%), previous acute myocarditis (7%), 20% were former smokers and 7% active smoker. The main clinical presentation was chest pain (27%), dyspnea<span style="color:black">/heart failure </span>(47%) and epigastric pain/nausea (13%). The media between symptom onset and hospitalization was 14,9±6,5 days. The total hospital length of stay was 37±6,9 days, with <span style="color:black">18,7</span>±16,1 <span style="color:black">days in the ICU</span><span style="color:#00b050">. </span> During hospitalization, arrhythmias were documented in 40%: atrial fibrillation/flutter (13%), complete atrioventricular block (13%), ventricular tachycardia (13%), ventricular fibrillation (7%), asystole (7%) and electrical storm (7%). Medical therapy included corticosteroids in 47% of P, immunosuppressive therapy in 13% and intravenous immunoglobulin in 13%. The mean duration of VA-ECMO support was 8,5±6,2 days. 27% had preserved left ventricular systolic ejection fraction (LVEF), 13% left ventricular dilation, 13% pericardial effusion and 13% late gadolinium enhancement. The mean LVEF was 23±8,2%. Endomyocardial biopsy was diagnostic for 3 out of 4P in which was performed. The etiology of myocarditis was identified in 60% of P: viral (33%), autoimmune (7%) and pheochromacitoma (20%). During hospitalization 5P (33%) died (3 in the ICU). The P who died had higher liver sequential organ failure assessment (SOFA) and kidney SOFA scores before starting ECMO, both being predictors of mortality (liver SOFA:Cramér'sV 0,76;95%CI 0,009-0,014;p=0,01;kidney SOFA:Cramér'sV 0,79;95% CI 0,03-0,04; p=0,031). At discharge , the survival rate was 67% and the recovery of LVEF ocurred in 47% of P. During follow-up, there were no re-hosp, recurrence of myocarditis or deaths and 53% of P had preserved LVEF.</span></span></p> <p><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">Conclusion: A<span style="background-color:white"><span style="color:black">FM is associated with high mortality rates. P</span></span>ercutaneous VA-ECMO is a highly effective haemodynamic support that can be used as a “bridge to recovery”. Once a patient recovers, the subsequent clinical outcome seems favourable.</span></span></span></span></p>
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