ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Heart Failure and Transplantation
Early Temporary Ventricular Assist Device Intervention Improves Survival in Fulminant Myocarditis with Cardiogenic Shock: Experience from A Single Centre and National Cohort
JIUN-YU LIN 1,2,3
Chien-Sung Tsai 4,2
Yi-Ting Tsai 1,2
Chih-Yuan Lin 1,2
Hung-Yen Ke 1,2
Yi-Chang Lin 1,2
Jia-Lin Chen 5,2
Hsiang-Yu Yang 1,2
Wu-Chien Chien 6,7
Tsu-Hsuan Weng 7
Po-Shun Hsu 1
1. Division of Cardiovascular Surgery, Department of Surgery, Tri-Service General Hospital, Taipei, Taiwan
2. National Defense Medical University, Taipei City, Taiwan
3. Department of Cardiovascular Surgery, Nantou Hospital, Nantou, Taiwan
4. Division of Cardiovascular Surgery, Tri-Service General Hospital Department of Surgery, Taipei City, Taiwan
5. Department of Anesthesia, Tri-Service General Hospital, Taipei, Taiwan
6. School of Public Health, National Defense Medical University, Taipei City, Taiwan
7. Department of Medical Research, Tri-Service General Hospital, Taipei, Taiwan
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Abstract
Background: Acute fulminant myocarditis (AFM) complicated by cardiogenic shock (CS) often leads to rapid multi-organ failure. While extracorporeal life support (ECLS) is commonly used as an initial stabilizing measure, mortality remains high, particularly in patients requiring extracorporeal cardiopulmonary resuscitation (ECPR). Temporary ventricular assist devices (VADs) offer superior organ perfusion and more physiological hemodynamics compared to ECLS. Method: This retrospective study analyzed 16 AFM patients with CS who underwent VAD implantation following ECPR between December 2015 and February 2024. Clinical data, including laboratory profiles, vasopressor use, echocardiographic findings, and neurological status, were assessed. In parallel, survival outcomes from the Taiwan National Health Insurance Research Database (NHIRD) were compared among AFM patients treated with ECMO, VAD, or no mechanical circulatory support (MCS). Result: Of the 16 patients, 12 survived (75%) and 10 achieved cardiac recovery. Pre-VAD pulmonary artery pressure >40 mmHg and failure to wean from epinephrine by postoperative day 1 were associated with mortality. NHIRD analysis of 1,731 myocarditis patients showed the highest 30-day survival in the VAD group (88%) compared to ECMO (52%) or no MCS (71%; p = 0.003). Conclusion: AFM with CS often rapidly progresses to multi-organ failure. While ECMO provides initial circulatory support, survival remains poor once initiated. Early transition from ECMO to VAD is critical in improving survival for AFM patients with CS, particularly those receiving ECPR.
Summary
Keywords
Acute fulminant myocarditis, Cardiogenic shock (CS), ECMO - extracorporeal membrane oxygenation, INTENSIVE & CRITICAL CARE, VAD = ventricular access device
Received
17 October 2025
Accepted
12 January 2026
Copyright
© 2026 LIN, Tsai, Tsai, Lin, Ke, Lin, Chen, Yang, Chien, Weng and Hsu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Po-Shun Hsu
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