Accelerated LVAD pump thrombosis in COVID‐19 patient: Case report and mini review

Abstract

Background Coronavirus (COVID‐19) infection exposes patients with heart failure specially who are on mechanical support to a higher risk of morbidity and mortality. Aims To investigate the impact of COVID‐19 infection on left ventricular assist device (LVAD) thrombosis in heart failure patients. Materials & Methods We searched the medical electronic records, Medline, PubMed and Cochrane databases for; (LVAD) AND (thrombosis)) AND (covid‐19)) AND (heart failure). We divided cases reported into, LVAD thrombosis with COVID‐19 infection and compare them with LVAD thrombosis without COVID‐19 infection. Demographic data, LVAD device, presentation, treatment and outcomes were reviewed in all the LVAD thrombosis patients. Results In addition to our case, 8 other cases of LVAD thrombosis associated with COVID and 9 cases of LVAD thrombosis without covid infection were found. Patients with Covid infection had worse presentation and outcomes (3 deaths VS. 1 death in non‐covid group). Discussion In LVAD patients, pump malfunction due to thrombus development in the inflow cannula, device body, or outflow graft can result in hemodynamic instability, hemolysis and other life‐threatening complications. COVID infection significantly increases the risk of mortality in LVAD patient by accelerating the pump thrombosis due to elevated levels of endothelial protein C receptor and thrombomodulin along with procoagulants such as factor VIII, P‐selectin, and von Willebrand factor. Conclusion Significant morbidity and mortality are attributed to LVAD thrombosis, which are exasperated by prothrombotic conditions created in COVID‐19 infections.

Interaction of COVID-19 With Common Cardiovascular Disorders

“… 103 A few cases are available in the literature of LVAD pump thrombosis in the setting of COVID-19. 102 , 104 , 105 …”

“…103 A few cases are available in the literature of LVAD pump thrombosis in the setting of COVID-19. 102,104,105 Acute heart failure has also been described in COVID-19, dating back to the first cases in the United States from Washington state, where a third of patients developed acute cardiomyopathy within a cohort with an exceptionally high mortality rate of 67%. 106,107 In patients with severe COVID-19 who died in Wuhan, 49% developed acute heart failure during their course.…”