Mechanical Unloading by Fulminant Myocarditis: LV-IMPELLA, ECMELLA, BI-PELLA, and PROPELLA Concepts

J Cardiovasc Transl Res. 2019 Apr;12(2):116-123. doi: 10.1007/s12265-018-9820-2. Epub 2018 Aug 6.

Abstract

Mechanical circulatory support (MCS) is often required to stabilize patients with acute fulminant myocarditis with cardiogenic shock. This review gives an overview of the successful use of left-sided Impella in the setting of fulminant myocarditis and cardiogenic shock as the sole means of MCS as well as in combination with right ventricular (RV) support devices including extracorporeal life support (ECLS) (ECMELLA) or an Impella RP (BI-PELLA). It further provides evidence from endomyocardial biopsies that in addition to giving adequate support, LV unloading by Impella exhibits disease-modifying effects important for myocardial recovery (i.e., bridge-to-recovery) achieved by this newly termed "prolonged Impella" (PROPELLA) concept in which LV-IMPELLA 5.0, implanted via an axillary approach, provides support in awake, mobilized patients for several weeks. Finally, this review addresses the question of how to define the appropriate time point for weaning strategies and for changing or discontinuing unloading in fulminant myocarditis.

Keywords: Endomyocardial biopsies; Fulminant myocarditis; MALDI-imaging mass spectrometry; Mechanical circulatory support; Mechanical unloading; Metabolism; Weaning.

Publication types

  • Review

MeSH terms

  • Animals
  • Heart-Assist Devices*
  • Humans
  • Myocarditis / diagnosis
  • Myocarditis / mortality
  • Myocarditis / physiopathology
  • Myocarditis / therapy*
  • Prosthesis Design
  • Prosthesis Implantation / adverse effects
  • Prosthesis Implantation / instrumentation*
  • Prosthesis Implantation / mortality
  • Recovery of Function
  • Shock, Cardiogenic / diagnosis
  • Shock, Cardiogenic / mortality
  • Shock, Cardiogenic / physiopathology
  • Shock, Cardiogenic / therapy*
  • Treatment Outcome
  • Ventricular Function, Left*