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Ventricular assist device support as a bridge to heart transplantation in patients with giant cell myocarditis
Author(s) -
Murray Lindsay K.,
GonzálezCostello Jose,
Jonas Samual N.,
Sims Daniel B.,
Morrison Kerry A.,
Colombo Paolo C.,
Mancini Donna M.,
Restaino Susan W.,
Joye Evan,
Horn Evelyn,
Takayama Hiroo,
Marboe Charles C.,
Naka Yoshifumi,
Jorde Ulrich P.,
Uriel Nir
Publication year - 2012
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1093/eurjhf/hfr174
Subject(s) - medicine , heart transplantation , immunosuppression , ventricular assist device , heart failure , myocarditis , cardiology , transplantation , regimen , surgery
Aims Giant cell myocarditis (GCM) carries a poor prognosis and many patients require end‐stage therapies. This study sought to determine the outcome of patients bridged with ventricular assist devices (VAD) to orthotopic heart transplantation (OHT). Methods and results A retrospective data collection of all patients with GCM was performed. Diagnosis was determined by endomyocardial or explanted heart biopsy. Eight patients were found, but two of those patients went directly to OHT and were excluded. The remaining six patients received VADs, and these patients, aged 44 ± 18 years, were included. Five of the six patients were bridged with biventricular support and one patient was supported by left ventricular assist device (LVAD) alone. Two patients died on device support. Four patients were bridged to OHT 77 ± 42 days after device implantation. All four patients bridged with a VAD are alive, with a mean follow‐up of 5.7 ± 4.1 years. Two patients were found to have recurrent GCM in the transplanted heart and were treated successfully with immunosuppression. Three patients had high grade (2R) rejection at 66 ± 52 days post‐OHT. Cardiac function was preserved in all patients, and only one patient had cardiac allograft vasculopathy. Conclusion Patients with end‐stage GCM can be successfully bridged with VADs to OHT with very good post‐OHT survival. The proper immunosuppressive regimen for this group needs further investigation given the frequency of rejection and GCM recurrence.