Managing Multiorgan Failure and Infection Before Durable LVAD in Fulminant Myocarditis.

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.