講演情報
[II-AHAJS-5]Mechanical Circulatory Support in Children with Fulminant Myocarditis
○Yusuke Ando, Hiromichi Sonoda, Tatsushi Onzuka, Kunihiko Joo, Tomoki Ushijima, Hirofumi Onitsuka, Hikaru Uchiyama, Akira Shiose (Department of Cardiovascular Surgery, Kyushu University, Fukuoka, Japan)
キーワード：
fulminant myocarditis、ECMO、ventricular unloading
Objectives: Venoarterial extracorporeal membrane oxygenation (V-A ECMO) is crucial for pediatric fulminant myocarditis but can increase afterload and cause left ventricular (LV) distention. We evaluated LV unloading during V-A ECMO. Methods: We analyzed 19 pediatric patients treated with V-A ECMO for fulminant myocarditis from 2010 to 2024. Patients were divided into ECMO alone (n=9) and ECMO with LV unloading (n=10). Indications for unloading included LV distention, pulmonary congestion, thrombi, and blood stagnation. LV unloading was done via transapical cannulation (n=9) or Impella (n=1). Four patients received unloading at ECMO initiation, six as rescue therapy. Median time to unloading was 281 minutes. Results: Baseline characteristics were similar, but extracorporeal CPR was more frequent in the unloading group (33% vs. 80%, P=0.07). Survival was higher in the unloading group (44% vs. 80%, P=0.17), with lower cardiac mortality (33% vs. 0%, P=0.09). Pulmonary congestion resolved faster in the unloading group (6 vs. 2 days, P＜0.05). Weaning rates from ECMO and ventilation were similar. Tamponade occurred more frequently in the unloading group (0% vs. 40%, P=0.09). No significant differences were seen in support duration, renal therapy, infection, stroke, or ejection fraction at recovery. Conclusion: LV unloading showed favorable trends with faster pulmonary recovery. Increased tamponade risk requires careful unloading method selection. Early unloading should be considered for LV distention or pulmonary congestion. Impella may reduce tamponade risk in larger children.