Abstract 13538: Trends in Utilization and Outcomes of Mechanical Circulatory Support for Patients With Myocarditis

Abstract

Introduction: Outcomes of mechanical circulatory support (MCS) to treat myocarditis are not well described. Hypothesis: We hypothesize that MCS is increasingly utilized for the treatment of myocarditis and is associated with high morbidity and mortality. Methods: This study utilized admissions from the National Inpatient Sample (NIS) from 2012-2016. Patient-encounters with myocarditis were identified using ICD-9/10 codes. Weighted population estimate outcomes comparing encounters with MCS or without MCS were calculated. Mode of MCS was examined and trends in MCS treatment, mortality and morbidity were assessed using logistic regression models. Results: Of the 48,965 encounters for myocarditis between 2012 and 2016, 1,910 patients died (3.9%) and 255 (0.5%) underwent transplant. MCS was used in 2,215 patients (4.5%): extra corporeal membrane oxygenation (ECMO) in 590, durable ventricular assist device (VAD) in 150, temporary VAD (tVAD) in 320, and intra-aortic balloon pump (BP) in 770. Over 5 years there was no change in the frequency of MCS and mortality in MCS patients remained stable (p for trends >0.3 ). However, the use of ECMO increased from 23.2% in 2012 to 38.5% in 2016 while BP use decreased from 60.9% to 26.4% (p trend for both <0.05). Mortality (25.5% vs 2.9%), infection (32.7% vs 11.7%), stroke (10.2% vs 2.2%), bleeding events (16.0% vs 2.2%) and arrhythmia (58.9% vs 29.0%), were higher in MCS (p for all <0.0001). Incidence of mortality, stroke, and bleeding differed by mode of MCS support {ECMO (31.2%, 15.3%, 23.7%), BP (18.2%, 4.6%, 7.8%), tVAD (26.6%, 4.7%, 7.8%) and VAD (6.7%, 6.7%, 16.7%) (p for all <0.05)} with ECMO having the highest number of complications. Conclusion: MCS is utilized in 5% of patients with myocarditis. ECMO has become the most common support modality, but its use is associated with significant morbidity and mortality. Further evaluation of how patient characteristics influence the MCS type utilized and their impact on outcomes is needed.