Cargando…

Outcomes of Mechanical Circulatory Support for Giant Cell Myocarditis: A Systematic Review

Treatment of giant cell myocarditis (GCM) can require bridging to orthotopic heart transplantation (OHT) or recovery with mechanical circulatory support (MCS). Since the roles of MCS and immunotherapy are not well-defined in GCM, we sought to analyze outcomes of patients with GCM who required MCS. A...

Descripción completa

Detalles Bibliográficos
Autores principales: Patel, Preeyal M., Saxena, Abhiraj, Wood, Chelsey T., O’Malley, Thomas J., Maynes, Elizabeth J., Entwistle, John W. C., Massey, H. Todd, Pirlamarla, Preethi R., Alvarez, René J., Cooper, Leslie T., Rame, J. Eduardo, Tchantchaleishvili, Vakhtang
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7761005/
https://www.ncbi.nlm.nih.gov/pubmed/33271929
http://dx.doi.org/10.3390/jcm9123905
_version_ 1783627466645962752
author Patel, Preeyal M.
Saxena, Abhiraj
Wood, Chelsey T.
O’Malley, Thomas J.
Maynes, Elizabeth J.
Entwistle, John W. C.
Massey, H. Todd
Pirlamarla, Preethi R.
Alvarez, René J.
Cooper, Leslie T.
Rame, J. Eduardo
Tchantchaleishvili, Vakhtang
author_facet Patel, Preeyal M.
Saxena, Abhiraj
Wood, Chelsey T.
O’Malley, Thomas J.
Maynes, Elizabeth J.
Entwistle, John W. C.
Massey, H. Todd
Pirlamarla, Preethi R.
Alvarez, René J.
Cooper, Leslie T.
Rame, J. Eduardo
Tchantchaleishvili, Vakhtang
author_sort Patel, Preeyal M.
collection PubMed
description Treatment of giant cell myocarditis (GCM) can require bridging to orthotopic heart transplantation (OHT) or recovery with mechanical circulatory support (MCS). Since the roles of MCS and immunotherapy are not well-defined in GCM, we sought to analyze outcomes of patients with GCM who required MCS. A systematic search was performed in June 2019 to identify all studies of biopsy-proven GCM requiring MCS after 2009. We identified 27 studies with 43 patients. Patient-level data were extracted for analysis. Median patient age was 45 (interquartile range (IQR): 32–57) years. 42.1% (16/38) were female. 34.9% (15/43) presented in acute heart failure. 20.9% (9/43) presented in cardiogenic shock. Biventricular (BiVAD) MCS was required in 76.7% (33/43) of cases. Of the 62.8% (27/43) of patients who received immunotherapy, 81.5% (22/27) used steroids combined with at least one other immunosuppressant. Cyclosporine was the most common non-steroidal agent, used in 40.7% (11/27) of regimens. Immunosuppression was initiated before MCS in 59.3% (16/27) of cases, after MCS in 29.6% (8/27), and not specified in 11.1% (3/27). Immunosuppression started prior to MCS was associated with significantly better survival than MCS alone (p = 0.006); 60.5% (26/43) of patients received bridge-to-transplant MCS; 39.5% (17/43) received bridge-to-recovery MCS; 58.5% (24/41) underwent OHT a median of 104 (58–255) days from diagnosis. GCM recurrence after OHT was reported in 8.3% (2/24) of transplanted cases. BiVAD predominates in mechanically supported patients with GCM. Survival and bridge to recovery appear better in patients on immunosuppression, especially if initiated before MCS.
format Online
Article
Text
id pubmed-7761005
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-77610052020-12-26 Outcomes of Mechanical Circulatory Support for Giant Cell Myocarditis: A Systematic Review Patel, Preeyal M. Saxena, Abhiraj Wood, Chelsey T. O’Malley, Thomas J. Maynes, Elizabeth J. Entwistle, John W. C. Massey, H. Todd Pirlamarla, Preethi R. Alvarez, René J. Cooper, Leslie T. Rame, J. Eduardo Tchantchaleishvili, Vakhtang J Clin Med Article Treatment of giant cell myocarditis (GCM) can require bridging to orthotopic heart transplantation (OHT) or recovery with mechanical circulatory support (MCS). Since the roles of MCS and immunotherapy are not well-defined in GCM, we sought to analyze outcomes of patients with GCM who required MCS. A systematic search was performed in June 2019 to identify all studies of biopsy-proven GCM requiring MCS after 2009. We identified 27 studies with 43 patients. Patient-level data were extracted for analysis. Median patient age was 45 (interquartile range (IQR): 32–57) years. 42.1% (16/38) were female. 34.9% (15/43) presented in acute heart failure. 20.9% (9/43) presented in cardiogenic shock. Biventricular (BiVAD) MCS was required in 76.7% (33/43) of cases. Of the 62.8% (27/43) of patients who received immunotherapy, 81.5% (22/27) used steroids combined with at least one other immunosuppressant. Cyclosporine was the most common non-steroidal agent, used in 40.7% (11/27) of regimens. Immunosuppression was initiated before MCS in 59.3% (16/27) of cases, after MCS in 29.6% (8/27), and not specified in 11.1% (3/27). Immunosuppression started prior to MCS was associated with significantly better survival than MCS alone (p = 0.006); 60.5% (26/43) of patients received bridge-to-transplant MCS; 39.5% (17/43) received bridge-to-recovery MCS; 58.5% (24/41) underwent OHT a median of 104 (58–255) days from diagnosis. GCM recurrence after OHT was reported in 8.3% (2/24) of transplanted cases. BiVAD predominates in mechanically supported patients with GCM. Survival and bridge to recovery appear better in patients on immunosuppression, especially if initiated before MCS. MDPI 2020-12-01 /pmc/articles/PMC7761005/ /pubmed/33271929 http://dx.doi.org/10.3390/jcm9123905 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Patel, Preeyal M.
Saxena, Abhiraj
Wood, Chelsey T.
O’Malley, Thomas J.
Maynes, Elizabeth J.
Entwistle, John W. C.
Massey, H. Todd
Pirlamarla, Preethi R.
Alvarez, René J.
Cooper, Leslie T.
Rame, J. Eduardo
Tchantchaleishvili, Vakhtang
Outcomes of Mechanical Circulatory Support for Giant Cell Myocarditis: A Systematic Review
title Outcomes of Mechanical Circulatory Support for Giant Cell Myocarditis: A Systematic Review
title_full Outcomes of Mechanical Circulatory Support for Giant Cell Myocarditis: A Systematic Review
title_fullStr Outcomes of Mechanical Circulatory Support for Giant Cell Myocarditis: A Systematic Review
title_full_unstemmed Outcomes of Mechanical Circulatory Support for Giant Cell Myocarditis: A Systematic Review
title_short Outcomes of Mechanical Circulatory Support for Giant Cell Myocarditis: A Systematic Review
title_sort outcomes of mechanical circulatory support for giant cell myocarditis: a systematic review
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7761005/
https://www.ncbi.nlm.nih.gov/pubmed/33271929
http://dx.doi.org/10.3390/jcm9123905
work_keys_str_mv AT patelpreeyalm outcomesofmechanicalcirculatorysupportforgiantcellmyocarditisasystematicreview
AT saxenaabhiraj outcomesofmechanicalcirculatorysupportforgiantcellmyocarditisasystematicreview
AT woodchelseyt outcomesofmechanicalcirculatorysupportforgiantcellmyocarditisasystematicreview
AT omalleythomasj outcomesofmechanicalcirculatorysupportforgiantcellmyocarditisasystematicreview
AT mayneselizabethj outcomesofmechanicalcirculatorysupportforgiantcellmyocarditisasystematicreview
AT entwistlejohnwc outcomesofmechanicalcirculatorysupportforgiantcellmyocarditisasystematicreview
AT masseyhtodd outcomesofmechanicalcirculatorysupportforgiantcellmyocarditisasystematicreview
AT pirlamarlapreethir outcomesofmechanicalcirculatorysupportforgiantcellmyocarditisasystematicreview
AT alvarezrenej outcomesofmechanicalcirculatorysupportforgiantcellmyocarditisasystematicreview
AT cooperlesliet outcomesofmechanicalcirculatorysupportforgiantcellmyocarditisasystematicreview
AT ramejeduardo outcomesofmechanicalcirculatorysupportforgiantcellmyocarditisasystematicreview
AT tchantchaleishvilivakhtang outcomesofmechanicalcirculatorysupportforgiantcellmyocarditisasystematicreview