Abstract
IntroductionThere is limited data regarding the outcomes of patients (pts) with myocarditis/inflammatory cardiomyopathies (CM) who receive mechanical circulatory support (MCS) therapy. We sought to compare overall survival and clinical outcomes between pts who received MCS with myocarditis vs. those with idiopathic dilated CM (DCM).MethodsUsing the INTERMACS registry, we performed a retrospective analysis of all adult pts who received a primary MCS device from 6/1/06 to 12/31/16. Clinical characteristics and outcomes of MCS recipients with myocarditis were compared to idiopathic DCM.ResultsAmong 19,012 INTERMACS pts, 329 pts (1.7%) had myocarditis and 5,978 pts had idiopathic DCM (31.4%). The myocarditis MCS pts were younger (age 50+14 vs. 54+13, p<0.001), more likely to be white (70% vs. 57%, p=0.006), and less likely to be men (70% vs. 76%, p<0.001). Myocarditis pts were sicker at time of MCS implant as evidenced by INTERMACS profile (Profile 122% vs. 15%, p=0.001), presence of pre-operative arrhythmias (33% vs. 27%, p=0.01), need for temporary circulatory support including IABP and ECMO (39% vs. 25%, p<0.001). Early after MCS (<3 months after implant), myocarditis pts had a higher rate of bleeding, arrhythmias (both supraventricular and ventricular), non-device related infections, renal dysfunction, neurological dysfunction (not CVA), and respiratory failure compared with the idiopathic DCM group. The myocarditis cohort was not at increased risk for late AEs (>3 months) compared with idiopathic DCM pts. Myocarditis pts had comparable 1 and 2 year survival (80% 1 year and 72% 2 year) to idiopathic DCM pts (84% 1 year and 76% 2 year, log rank p value 0.15). The myocarditis group was at higher risk for in hospital mortality during index hospitalization (8.8% vs 4.8%, p=0.001). MCS device explantation due to recovery was more common among myocarditis pts (5.5% vs. 2.3%, p < 0.001).ConclusionsIn the largest myocarditis cohort to receive MCS to date, we found that the myocarditis population is younger, but much sicker than DCM pts at implant. MCS is associated with an increased risk of early AEs and in-hospital mortality, but the rate of late AEs and survival is similar to DCM. Our findings support safety and efficacy of MCS in the myocarditis population.