916-86 Percutaneous Cardiopulmonary Bypass Support (PCPS) for the Treatment of Acute Fulminant Myocarditis Unresponsive to Maximum Medical Therapy

Abstract

Some acute myocarditis is refractory to conventional therapies including IASP and is rapidly culminating in death without extracorporeal circulatory support. In order to study possible effectiveness of PCPS against this subgroup, acute fulminant myocarditis (AFM), we have reviewed our experiences and have examined the clinical outcome following PCPS treatment. Since 1986, we have applied emergency PCPS to 10 AFM pts (mean 38 years) with rapidly progressive cardiac dysfunction and sustained wide GRS VT/vf with hemodynamic collapse. The average interval from the onset of the very early signs of AFM (common cold like symptoms) to the induction of PCPS was 5.2 days. IASP was routinely applied before, during and after PCPS. Nafamostat mesilate (1 mg/kg/hr,iv) was also administered in combination with Heparin (ACT > 200 sec) as prophylaxis for bleeding complications. Histological examinations obtained from 12 endomyocardial biopsies and 2 autopsies revealed various inflamatory changes in myocardium in all of the 8 pts examined. Although the courses and degree of recovery varied among the pts, PCPS could be eventually weaned in all pts after a mean of 167 hours (ranging 37–302 hours). After the removal of PCPS, 2 old pts ( > 70 years) expired within 1 week due to sepsis and 1 pt expired 4 months later due to multiple organ failure. Seventy percent of pts (7 of 10) survived, 6 pts recovered to show normal cardiac function (mean EF = 0.62) and 1 pt showed DCM like chronic heart failure (EF = 0.321 Although nonsustained VT was observed in 3 of 7 survivors. they have been experiencing an event free follow-up period (mean 4.8 years). Hemodynamic support by PCPS in the acute phase of AFM was shown to be an effective treatment and the long-term outcome of the survivors was shown to be excellent in the majority of the cases.