Skip to main content
SpringerLink
Log in

Mechanical Assist Devices and Heart Transplantation

  • Chapter
  • First Online:
Myocarditis

Abstract

Myocarditis is an inflammatory disease of the myocardium, due to several causes, often underdiagnosed, and it may be responsible for acute (or even fulminant) or chronic heart failure. In this scenario, the first aim of the cardiac surgeon becomes saving the patients’ life (“bridge to life”), obtaining their clinical stabilization, and allowing diagnosis. For this purpose, mechanical circulatory support (MCS) devices are widely used in cardiac surgery with the intent to treat acute and chronic heart failure, not responsive to medical therapies. The extracorporeal circulatory support allows critical patients to gain and maintain hemodynamic stability until a partial or complete cardiac function is restored (short-term). If myocardial recovery is not achievable, other surgical options (long-term) are available. Heart transplant remains the optimal therapeutic solution, but it is not always available due to shortage of compatible donors, especially in pediatric recipients. Myocarditis, due to any causes, does not represent a contraindication for transplantation, but in some forms (e.g., acute infection, giant cell myocarditis, etc.) this option needs to be accurately evaluated. Finally, long-term devices (included biventricular support as total artificial heart) may be considered to bridge patients to transplant or less frequently as destination therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Abbreviations

CE:

European community certification

CRT:

Cardiac resynchronization therapy

CS:

Cardiogenic shock

DCM:

Dilated cardiomyopathy

ecBiVAD:

Extracorporeal biventricular assist device

ECLS:

Extracorporeal life support

ECMO:

Extracorporeal membrane oxygenator

FDA:

Food and drug administration

HF:

Heart failure

IABP:

Intra-aortic balloon counterpulsation

ICD:

Implantable cardioverter device

MCS:

Mechanical circulatory support

MODS:

Multiorgan dysfunction syndrome

SIRS:

Systemic inflammatory response

TEE:

Transesophageal echocardiogram

References

  1. Fung G, Luo H, Qiu Y, Yang D, McManus B. Myocarditis. Circ Res. 2016;118(3):496–514.

    Article  CAS  Google Scholar 

  2. Cooper LT Jr. Myocarditis. N Engl J Med. 2009;360(15):1526–38.

    Article  CAS  Google Scholar 

  3. Caforio ALP, Pankuweit S, Arbustini E, Basso C, Gimeno-Blanes J, Felix SB, Fu M, Heliö T, Heymans S, Jahns R, Klingel K, Linhart A, Maisch B, McKenna W, Mogensen J, Pinto YM, Ristic A, Schultheiss H-P, Seggewiss H, Tavazzi L, Thiene G, Yilmaz A, Charron P, Elliott PM. Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J. 2013;34(33):2636–48.

    Article  Google Scholar 

  4. Caforio AL, Calabrese F, Angelini A, Tona F, Vinci A, Bottaro S, Ramondo A, Carturan E, Iliceto S, Thiene G, Daliento L. A prospective study of biopsy-proven myocarditis: prognostic relevance of clinical and aetiopathogenetic features at diagnosis. Eur Heart J. 2007;28(11):1326–33.

    Article  Google Scholar 

  5. Grün S, Schumm J, Greulich S, Wagner A, Schneider S, Bruder O, Kispert EM, Hill S, Ong P, Klingel K, Kandolf R, Sechtem U, Mahrholdt H. Long-term follow-up of biopsy-proven viral myocarditis: predictors of mortality and incomplete recovery. J Am Coll Cardiol. 2012;59(18):1604–15.

    Article  Google Scholar 

  6. Cooper LT, Baughman KL, Feldman AM, Frustaci A, Jessup M, Kuhl U, Levine GN, Narula J, Starling RC, Towbin J, Virmani R, American Heart Association; American College of Cardiology; European Society of Cardiology; Heart Failure Society of America; Heart Failure Association of the European Society of Cardiology. The role of endomyocardial biopsy in the management of cardiovascular disease: a scientific statement from the American Heart Association, the American College of Cardiology, and the European Society of Cardiology. Endorsed by the Heart Failure Society of America and the Heart Failure Association of the European Society of Cardiology. J Am Coll Cardiol. 2007;50(19):1914–31.

    Article  Google Scholar 

  7. Cooper LT Jr, Keren A, Sliwa K, Matsumori A, Mensah GA. The global burden of myocarditis: part 1: a systematic literature review for the global burden of diseases, injuries, and risk factors 2010 study. Global Heart. 2014;9:121–9.

    Article  Google Scholar 

  8. Caforio ALP, Malipiero G, Marcolongo R, Iliceto S. Myocarditis: a clinical overview. Curr Cardiol Rep. 2017;19(7):63.

    Article  CAS  Google Scholar 

  9. Caforio AL, Marcolongo R, Basso C, Iliceto S. Clinical presentation and diagnosis of myocarditis. Heart. 2015;101(16):1332–44.

    Article  CAS  Google Scholar 

  10. McCarthy RE 3rd, Boehmer JP, Hruban RH, Hutchins GM, Kasper EK, Hare JM, Baughman KL. Long-term outcome of fulminant myocarditis as compared with acute (nonfulminant) myocarditis. N Engl J Med. 2000;342(10):690–5.

    Article  Google Scholar 

  11. Sagar S, Liu PP, Cooper LT Jr. Myocarditis. Lancet. 2012;379:738–47. https://doi.org/10.1016/S0140-6736(11)60648-X.

    Article  PubMed  Google Scholar 

  12. Pollack A, Kontorovich AR, Fuster V, Dec GW. Viral myocarditis—diagnosis, treatment options, and current controversies. Nat Rev Cardiol. 2015;12(11):670–80.

    Article  Google Scholar 

  13. Ammirati E, Cipriani M, Lilliu M, Sormani P, Varrenti M, Raineri C, Petrella D, Garascia A, Pedrotti P, Roghi A, Bonacina E, Moreo A, Bottiroli M, Gagliardone MP, Mondino M, Ghio S, Totaro R, Turazza FM, Russo CF, Oliva F, Camici PG, Frigerio M. Survival and left ventricular function changes in fulminant versus nonfulminant acute myocarditis. Circulation. 2017;136(6):529–45.

    Article  Google Scholar 

  14. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P, ESC Scientific Document Group. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016;37(27):2129–200.

    Article  Google Scholar 

  15. Pinney SP, Anyanwu AC, Lala A, et al. Left ventricular assist devices for lifelong support. J Am Coll Cardiol. 2017;69(23):2845–61.

    Article  Google Scholar 

  16. Saito S, Toda K, Miyagawa S, Yoshikawa Y, Hata H, Yoshioka D, Domae K, Tsukamoto Y, Sakata Y, Sawa Y. Diagnosis, medical treatment, and stepwise mechanical circulatory support for fulminant myocarditis. J Artif Organs. 2018;21(2):172–9.

    Article  Google Scholar 

  17. ElAmm CA, Al-Kindi SG, Oliveira GH. Characteristics and outcomes of patients with myocarditis listed for heart transplantation. Circ Heart Fail. 2016;9:e003259.

    Article  Google Scholar 

  18. Stevenson LW, Pagani FD, Young JB, et al. INTERMACS profiles of advanced heart failure: the current picture. J Heart Lung Transplant. 2009;28:535–41.

    Article  Google Scholar 

  19. Lahpor J, Khaghani A, Hetzer R, et al. European results with a continuous-flow ventricular assist device for advanced heart-failure patients. Eur J Cardiothorac Surg. 2010;37(2):357–61.

    PubMed  Google Scholar 

  20. Werdan K, Gielen S, Ebelt H, et al. Mechanical circulatory support in cardiogenic shock. Eur Heart J. 2014;35:156–67.

    Article  CAS  Google Scholar 

  21. Kirklin JK, Pagani FD, Kormos RL, Stevenson LW, Blume ED, Myers SL, Miller MA, Baldwin JT, Young JB, Naftel DC. Eighth annual INTERMACS report: special focus on framing the impact of adverse events. J Heart Lung Transplant. 2017;36:1080–6.

    Article  Google Scholar 

  22. Ouwenee lDM, Henriques JPS. Percutaneous cardiac support devices for cardiogenic shock: current indications and recommendations. Heart. 2012;98:1246–54.

    Article  Google Scholar 

  23. Morales DLS, Rossano JW, VanderPluym C, Lorts A, Cantor R, St Louis J, Koeh D, Sutcliffe DL, Adachi I, Kirklin JK, Rosenthal DN, Blume ED, Pedimacs Investigators. Third annual pediatric interagency registry for mechanical circulatory support (Pedimacs) report: pre-implant characteristics and outcomes. Ann Thorac Surg. 2019;107:993–1004.

    Article  Google Scholar 

  24. Tarzia V, Bortolussi G, Bianco R, et al. Extracorporeal life support in cardiogenic shock: impact of acute versus chronic etiology on outcome. J Thorac Cardiovasc Surg. 2015;150(2):333–40.

    Article  Google Scholar 

  25. Kuchibhotla S, Esposito ML, Breton C, Pedicini R, Mullin A, O’Kelly R, Anderson M, Morris DL, Batsides G, Ramzy D, Grise M, Pham DT, Kapur NK. Acute biventricular mechanical circulatory support for cardiogenic shock. J Am Heart Assoc. 2017;6:e006670. https://doi.org/10.1161/JAHA.117.006670.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Nagatomo Y, McNamara DM, Alexis JD, Cooper LT, Dec GW, Pauly DF, Sheppard R, Starling RC, Tang WH, IMAC-2 Investigators. Myocardial recovery in patients with systolic heart failure and autoantibodies against β(1)-adrenergic receptors. J Am Coll Cardiol. 2017;69(8):968–77.

    Article  CAS  Google Scholar 

  27. Wojnicz R, Nowalany-Kozielska E, Wojciechowska C, et al. Randomized, placebo-controlled study for immunosuppressive treatment of inflammatory dilated cardiomyopathy: two-year follow-up results. Circulation. 2001;104:39–45.

    Article  CAS  Google Scholar 

  28. Slaughter MS, Rogers JG, Milano CA, Russell SD, Conte JV, Feldman D, Sun B, Tatooles AJ, Delgado RM 3rd, Long JW, Wozniak TC, Ghumman W, Farrar DJ, Frazier OH, HeartMate II Investigators. Advanced heart failure treated with continuous-flow left ventricular assist device. N Engl J Med. 2009;361(23):2241–51.

    Article  CAS  Google Scholar 

  29. den Uil CA, Akin S, Jewbali LS, dos ReisMiranda D, Brugts JJ, Constantinescu A, Arie Pieter Kappetein AP, Caliskan K. Short-term mechanical circulatory support as a bridge to durable left ventricular assist device implantation in refractory cardiogenic shock: a systematic review and meta-analysis. Eur J Cardiothorac Surg. 2017;52:14–25.

    Article  Google Scholar 

  30. Carrozzini M, Bejko J, Guariento A, Rubino M, Bianco R, Tarzia V, Gregori D, Bottio T, Gerosa G. Minimally invasive implantation of continuous flow left ventricular assist devices: the evolution of surgical techniques in a single-center experience. Artif Organs. 2019;43:E41–52.

    Article  Google Scholar 

  31. Tarzia V, Buratto E, Gallo M, Bortolussi G, Bejko J, Bianco R, Bottio T, Gerosa G. Implantation of the HeartWare HVAD: from full sternotomy to less invasive techniques. Ann Cardiothorac Surg. 2014;3(5):535–7.

    PubMed  PubMed Central  Google Scholar 

  32. Tarzia V, Buratto E, Gallo M, Bortolussi G, Bejko J, Dal Lin C, Torregrossa G, Bianco R, Bottio T, Gerosa G. Surgical implantation of the CardioWest total artificial heart. Ann Cardiothorac Surg. 2014;3(6):624–5.

    PubMed  PubMed Central  Google Scholar 

  33. Kawabori M, Kurihara C, Miller Y, Heck KA, Bogaev RC, Civitello AB, Cohn WE, Frazier OH, Morgan JA. Total artificial heart implantation for biventricular failure due to eosinophilic myocarditis. J Artif Organs. 2017;20(3):266–9.

    Article  Google Scholar 

  34. El Banayosy A, Arusoglu L, Morshius M, et al. Cardiowest total artificial heart: bad Oeynhausen experience. Ann Thorac Surg. 2005;80:548–52.

    Article  Google Scholar 

  35. Kirsch MEW, Nguyen A, Mastroianni C, et al. Syncardia temporary total artificial heart as bridge to transplantation: current results at la pitiè hospital. Ann Thoracic Surg. 2013;95:1640–6.

    Article  Google Scholar 

  36. Torregrossa G, Morshuis M, Varghese R, et al. Results with syncardia total artificial heart beyond 1 year. ASAIO J. 2014;60:626–34.

    Article  Google Scholar 

  37. Pietra BA, Kantor PF, Bartlett HL, Chin C, Canter CE, Larsen RL, Edens RE, Colan SD, Towbin JA, Lipshultz SE, Kirklin JK, Naftel DC, Hsu DT. Early predictors of survival to and after heart transplantation in children with dilated cardiomyopathy. Circulation. 2012;126:1079–86.

    Article  Google Scholar 

  38. Höyer S, Berglin E, Pettersson G, Edvardsson N, Waagstein F. Cardiac transplantation in patients with active myocarditis. Transplant Proc. 1990;22:1450.

    PubMed  Google Scholar 

  39. Yoshizawa S, Kato TS, Mancini D, Marboe CC. Outcome of patients having heart transplantation for lymphocytic myocarditis. Am J Cardiol. 2013;112:405–10.

    Article  Google Scholar 

  40. Garbern JC, Gauvreau K, Blume ED, Singh TP. Is myocarditis an independent risk factor for post-transplant mortality in pediatric heart transplant recipients? Circ Heart Fail. 2016;9(1):e002328.

    Article  Google Scholar 

  41. Litovsky SH, Burke AP, Virmani R. Giant cell myocarditis: an entity distinct from sarcoidosis characterized by multiphasic myocyte destruction by cytotoxic T cells and histiocytic giant cells. Mod Pathol. 1996;9(12):1126–34.

    CAS  PubMed  Google Scholar 

  42. Maleszewski JJ, Orellana VM, Hodge DO, et al. Long-term risk of recurrence, morbidity and mortality in giant cell myocarditis. Am J Cardiol. 2015;115:1733–8.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Cardio-Thoracic and Vascular Science and Public Health, Unit of Cardiac Surgery, Padova, Italy

    Gino Gerosa, Assunta Fabozzo & Vincenzo Tarzia

Authors
  1. Gino Gerosa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Assunta Fabozzo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Vincenzo Tarzia
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gino Gerosa .

Editor information

Editors and Affiliations

  1. Cardiology, Department of Cardiac Thoracic Vascular Science and Public Health, University of Padova, Policlinico Universitario, Padova, Italy

    Alida L. P. Caforio

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Gerosa, G., Fabozzo, A., Tarzia, V. (2020). Mechanical Assist Devices and Heart Transplantation. In: Caforio, A. (eds) Myocarditis. Springer, Cham. https://doi.org/10.1007/978-3-030-35276-9_20

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-35276-9_20

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-35275-2

  • Online ISBN: 978-3-030-35276-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation