Key result
Durable mechanical circulatory support for myocarditis yielded overall survival noninferior to nonischemic cardiomyopathy (P=0.27 for LVAD), with higher rates of recovery by 12 months (5% vs 1.7%).
Why the study?
Myocarditis can be refractory to medical therapy and require durable mechanical circulatory support, but the characteristics and outcomes of these patients are not known.
Does durable mechanical circulatory support yield similar survival and recovery outcomes in patients with myocarditis compared to those with nonischemic cardiomyopathy?
Cohort (n=14,062)
Yes
Does durable mechanical circulatory support yield similar survival and recovery outcomes in patients with myocarditis compared to those with nonischemic cardiomyopathy?
p-value: p=0.27 (LVAD), 0.50 (BIVAD)
Patients receiving durable mechanical circulatory support for myocarditis have similar survival but higher rates of recovery compared to those with nonischemic cardiomyopathy, despite presenting with higher acuity.
Survival after durable MCS is similar in myocarditis and NICM; leaves open etiology-specific management needs.
Myocarditis can be refractory to medical therapy and require durable mechanical circulatory support (MCS). The characteristics and outcomes of these patients are not known. We identified all patients with clinically-diagnosed or pathology-proven myocarditis who underwent mechanical circulatory support in the International Society for Heart and Lung Transplantation Registry for Mechanically Assisted Circulatory Support registry (2013-2016). The characteristics and outcomes of these patients were compared to those of patients with nonischemic cardiomyopathy (NICM). Out of 14,062 patients in the registry, 180 (1.2%) had myocarditis and 6,602 (46.9%) had NICM. Among patients with myocarditis, duration of heart failure was <1 month in 22%, 1-12 months in 22.6%, and >1 year in 55.4%. Compared with NICM, patients with myocarditis were younger (45 vs. 52 years, P < 0.001) and were more often implanted with Interagency Registry for Mechanically Assisted Circulatory Support profile 1 (30% vs. 15%, P < 0.001). Biventricular mechanical support (biventricular ventricular assist device [BIVAD] or total artificial heart) was implanted more frequently in myocarditis (18% vs. 6.7%, P < 0.001). Overall postimplant survival was not different between myocarditis and NICM (left ventricular assist device: P = 0.27, BIVAD: P = 0.50). The proportion of myocarditis patients that have recovered by 12 months postimplant was significantly higher in myocarditis compared to that of NICM (5% vs. 1.7%, P = 0.0003). Adverse events (bleeding, infection, and neurologic dysfunction) were all lower in the myocarditis than NICM. In conclusion, although myocarditis patients who receive durable MCS are sicker preoperatively with higher needs for biventricular MCS, their overall MCS survival is noninferior to NICM. Patients who received MCS for myocarditis are more likely than NICM to have MCS explanted due to recovery, however, the absolute rates of recovery were low.
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Al‐Kindi et al. (2022) conducted a cohort in Myocarditis requiring durable mechanical circulatory support (n=14,062). Myocarditis vs. Nonischemic cardiomyopathy (NICM) was evaluated on Overall postimplant survival (p=0.27 (LVAD), 0.50 (BIVAD)). Durable mechanical circulatory support for myocarditis yielded overall survival noninferior to nonischemic cardiomyopathy (P=0.27 for LVAD), with higher rates of recovery by 12 months (5% vs 1.7%).
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