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Outcomes of Mechanical Circulatory Support for Giant Cell Myocarditis: A Systematic Review

Preeyal M Patel1, Abhiraj Saxena1, Chelsey T Wood1

  • 1Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA.

Journal of Clinical Medicine
|December 4, 2020
PubMed

Insights

Giant cell myocarditis (GCM) treatment often requires mechanical circulatory support (MCS). Immunosuppression, particularly before MCS initiation, significantly improves survival and bridge-to-recovery outcomes in GCM patients.

Area of Science:

  • Cardiology
  • Immunology
  • Critical Care Medicine

Background:

  • Giant cell myocarditis (GCM) is a rare and aggressive form of heart inflammation.
  • Treatment strategies for GCM, especially involving mechanical circulatory support (MCS) and immunotherapy, are not well-defined.
  • Patients with GCM often require advanced support, including MCS, to bridge to recovery or heart transplantation.

Purpose of the Study:

  • To analyze the outcomes of patients diagnosed with biopsy-proven GCM who required MCS.
  • To investigate the impact of immunotherapy timing on survival and bridge-to-recovery rates in MCS-supported GCM patients.

Main Methods:

  • A systematic literature search was conducted in June 2019, identifying studies of GCM patients requiring MCS published after 2009.
  • Patient-level data from 27 studies involving 43 patients were extracted and analyzed.
  • Outcomes were assessed based on MCS type, immunotherapy use and timing, bridge-to-transplant or bridge-to-recovery status, and orthotopic heart transplantation (OHT) outcomes.

Main Results:

  • Biventricular assist device (BiVAD) MCS was predominantly used (76.7%).
  • Of patients receiving immunotherapy (62.8%), most used steroids combined with other immunosuppressants (e.g., cyclosporine).
  • Initiating immunosuppression before MCS was associated with significantly better survival (p = 0.006) compared to MCS alone. Bridge-to-recovery rates were also improved.

Conclusions:

  • Biventricular MCS is the primary support method for GCM patients.
  • Immunotherapy, especially when initiated prior to MCS, is crucial for improving survival and facilitating bridge-to-recovery in GCM.
  • Orthotopic heart transplantation (OHT) is a viable option, with a low rate of GCM recurrence post-transplant.

Keywords:
immunosuppressionmechanical circulatory supportmyocarditissurvivaltreatment

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