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...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2020-12-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/9/12/3905 |
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| author | Preeyal M. Patel Abhiraj Saxena Chelsey T. Wood Thomas J. O’Malley Elizabeth J. Maynes John W. C. Entwistle H. Todd Massey Preethi R. Pirlamarla René J. Alvarez Leslie T. Cooper J. Eduardo Rame Vakhtang Tchantchaleishvili |
| author_facet | Preeyal M. Patel Abhiraj Saxena Chelsey T. Wood Thomas J. O’Malley Elizabeth J. Maynes John W. C. Entwistle H. Todd Massey Preethi R. Pirlamarla René J. Alvarez Leslie T. Cooper J. Eduardo Rame Vakhtang Tchantchaleishvili |
| author_sort | Preeyal M. Patel |
| collection | DOAJ |
| 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 (<i>p</i> = 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. |
| first_indexed | 2024-03-10T14:23:55Z |
| format | Article |
| id | doaj.art-0cccda24c358495d8b2b47479313ad0b |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T14:23:55Z |
| publishDate | 2020-12-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-0cccda24c358495d8b2b47479313ad0b2023-11-20T23:08:22ZengMDPI AGJournal of Clinical Medicine2077-03832020-12-01912390510.3390/jcm9123905Outcomes of Mechanical Circulatory Support for Giant Cell Myocarditis: A Systematic ReviewPreeyal M. Patel0Abhiraj Saxena1Chelsey T. Wood2Thomas J. O’Malley3Elizabeth J. Maynes4John W. C. Entwistle5H. Todd Massey6Preethi R. Pirlamarla7René J. Alvarez8Leslie T. Cooper9J. Eduardo Rame10Vakhtang Tchantchaleishvili11Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USASidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USASidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USADivision of Cardiac Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, PA 19107, USADivision of Cardiac Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, PA 19107, USADivision of Cardiac Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, PA 19107, USADivision of Cardiac Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, PA 19107, USADivision of Cardiology, Department of Medicine, Thomas Jefferson University, Philadelphia, PA 19107, USADivision of Cardiology, Department of Medicine, Thomas Jefferson University, Philadelphia, PA 19107, USADepartment of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL 32224, USADivision of Cardiac Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, PA 19107, USADivision of Cardiac Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, PA 19107, USATreatment 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 (<i>p</i> = 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.https://www.mdpi.com/2077-0383/9/12/3905myocarditismechanical circulatory supportimmunosuppressiontreatmentsurvival |
| spellingShingle | Preeyal M. Patel Abhiraj Saxena Chelsey T. Wood Thomas J. O’Malley Elizabeth J. Maynes John W. C. Entwistle H. Todd Massey Preethi R. Pirlamarla René J. Alvarez Leslie T. Cooper J. Eduardo Rame Vakhtang Tchantchaleishvili Outcomes of Mechanical Circulatory Support for Giant Cell Myocarditis: A Systematic Review Journal of Clinical Medicine myocarditis mechanical circulatory support immunosuppression treatment survival |
| 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 | myocarditis mechanical circulatory support immunosuppression treatment survival |
| url | https://www.mdpi.com/2077-0383/9/12/3905 |
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