Mechanical Assist Devices and Heart Transplantation

Myocarditis is an inflammatory disease of the myocardium, due to several causes, often underdiagnosed, and it may be responsible for acute (or even fulminant) or chronic heart failure. In this scenario, the first aim of the cardiac surgeon becomes saving the patients’ life (“bridge to life”), obtaining their clinical stabilization, and allowing diagnosis. For this purpose, mechanical circulatory support (MCS) devices are widely used in cardiac surgery with the intent to treat acute and chronic heart failure, not responsive to medical therapies. The extracorporeal circulatory support allows critical patients to gain and maintain hemodynamic stability until a partial or complete cardiac function is restored (short-term). If myocardial recovery is not achievable, other surgical options (long-term) are available. Heart transplant remains the optimal therapeutic solution, but it is not always available due to shortage of compatible donors, especially in pediatric recipients. Myocarditis, due to any causes, does not represent a contraindication for transplantation, but in some forms (e.g., acute infection, giant cell myocarditis, etc.) this option needs to be accurately evaluated. Finally, long-term devices (included biventricular support as total artificial heart) may be considered to bridge patients to transplant or less frequently as destination therapy.