Key result
Temporary BiVAD and antifungal therapy successfully bridge refractory fulminant myocarditis complicated by candidemia to durable LVAD.
Why the study?
Fulminant myocarditis carries high rates of mortality, heart transplantation, or durable ventricular assist device implantation, and deciding when to transition to a durable device is challenging when complicated by multiorgan failure or infection.
Case Report (n=1)
This case report demonstrates that a surgical temporary biventricular assist device can serve as a bailout strategy to successfully bridge patients with fulminant myocarditis complicated by multiorgan failure and infection to a durable left ventricular assist device.
BACKGROUND: Fulminant myocarditis (FM) carries high rates of mortality, heart transplantation, or durable ventricular assist device (dVAD) implantation. Deciding when to transition to dVAD is challenging, particularly when complicated by multiorgan failure or infection. CASE SUMMARY: A 45-year-old man with FM was transitioned from a failing extracorporeal membrane oxygenation-Impella (combined use of venoarterial extracorporeal membrane oxygenation and Impella CP) to a surgical temporary biventricular assist device. Despite dialysis-dependent renal failure and Candida fungemia-which subsequently resolved under targeted antifungal therapy-he was successfully bridged to a HeartMate 3 (Abbott) durable left ventricular assist device as a bridge to simultaneous heart-kidney transplantation. DISCUSSION: This case highlights the importance of the multidisciplinary team in the management of FM complicated by multiorgan failure and infection. TAKE-HOME MESSAGES: In complicated FM, the transition to dVAD must be evaluated on a case-by-case basis by a multidisciplinary team. A surgical temporary biventricular assist device is a bailout strategy when standard percutaneous venting techniques fail during venoarterial extracorporeal membrane oxygenation.
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Bui et al. (2026) conducted a case report in Fulminant myocarditis complicated by multiorgan failure and Candida fungemia (n=1). Surgical temporary biventricular assist device bridging to HeartMate 3 durable left ventricular assist device was evaluated on Bridge to durable LVAD and simultaneous heart-kidney transplantation. Surgical temporary BiVAD and targeted antifungal therapy bridged 1 45-year-old man with fulminant myocarditis, renal failure, and Candida fungemia to a HeartMate 3 LVAD after failing ECMO-Impella.
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