TEMPORARY MECHANICAL SUPPORT WITH THE BVS-5000 ASSIST DEVICE DURING TREATMENT OF ACUTE MYOCARDITIS

Background: Ventricular support with the BVS 5000 (Abiomed) has been u sed as temporary circulatory assist for the failing heart. Our purpose is to summarize four cases illustrating the role of mechanical unload ing in acute myocarditis. Methods: Four patients aged 16- to 33-year o ld presented with congestive heart failure 4 to 20 days after a flu-li ke syndrome. All patients were in severe cardiogenic shock +/- renal a nd liver dysfunction. Ejection fraction ranged from 5% to 26%. Indicat ions for ventricular assist were failure of maximal medical treatment with greater than or equal to two inotropes +/- intra-aortic balloon p ump, Myocardial biopsy revealed acute myocarditis in three patients an d severe edema in one despite a characteristic clinical course, Two pa tients received immunotherapy with OKT3. Biventricular assist was used in three patients and left ventricular assist only was used in one. M ean support time was 8.3 days (7 to 11). Results: All patients had rec overy of myocardial function and were discharged from the hospital in good condition. Conclusion: The BVS 5000 device provides a safe, simpl e, and effective method to support the circulation during acute myocar ditis. We hypothesize that this may facilitate myocardial recovery by decompressing the distended ventricle. Ventricular assist devices shou ld be used early in the presence of hemodynamic deterioration on maxim al medical therapy.