Ventricular assist device for a coronavirus disease 2019‐affected heart

Abstract

Coronavirus disease 2019 (COVID‐19) is challenging the care for cardiovascular patients, resulting in serious consequences with increasing mortality in pre‐diseased heart failure patients. In the current state of the pandemic, the physiopathology of COVID‐19 affecting pre‐diseased hearts and the management of terminal heart failure in COVID‐19 patients remain unclear. We outline the findings of a young COVID‐19 patient suffering from idiopathic cardiomyopathy who was treated for acute multi‐organ failure and required cardiac surgery with implantation of a temporary right ventricular and durable left ventricular assist device (LVAD). For deeper translational insights, we used in‐depth tissue analysis by electron and light sheet fluorescence microscopy revealing evidence for spatial distribution of severe acute respiratory syndrome coronavirus 2 in the heart. This indicates that in‐depth analysis may represent a valuable tool in understanding indistinct clinical cases. We conclude that COVID‐19 directly affects pre‐diseased hearts, but the consequences can be treated successfully with LVAD implantation.

Providing safe perioperative care in cardiac surgery during the COVID-19 pandemic

“…However, the significantly elevated risk for coagulopathy and bleeding disorders should be appreciated in these patients. [ 35 , 36 , 37 , 38 , 57 ].…”

In-depth review of cardiopulmonary support in COVID-19 patients with heart failure

“…Patients with a preexisting history of heart failure are already in an increased risk for developing thromboembolism due to venous stasis, endothelial injury, ischemic cardiomyopathy and atrial fibrosis[ 63 , 64 ]. This condition might be worsened by the presence of COVID-19 infection which may trigger coagulopathy and the presence of implantable device which also may trigger thrombosis[ 65 , 66 ]. The pre-existing cardiopulmonary support such as left ventricular assisted device (LVAD) alone might increase the risk of developing pump thrombosis, although the risk of stroke with co-existing COVID-19 infection has not been assessed yet[ 3 , 67 ].…”

“…To the best of our knowledge, until now there are no specific indication of when to implant ventricular assist device (VAD) in the context of severe COVID-19. First reported case of VAD implantation in patient with COVID-19 infection demonstrate the possibility of VAD as an alternative in a setting of prolonged cardiogenic shock and hemodynamical instability with modest chance of VA ECMO weaning[ 65 ]. Careful consideration and assessment of patient’s clinical status has to be put in top priority in determining when to implant the device.…”

“…The pre-existing LVAD in severe COVID-19 infection may raise some concerns in the context of management. The risk of pump thrombosis has to be kept in mind, as hypercoagulability state in COVID-19 infection and the pump itself may induce thrombosis[ 65 ]. Despite of severe hypoxemia might improve by prone position, there is a specific concern of the outflow graft compression, driveline damage and elevated pressure in the right ventricle with subsequent right ventricular failure[ 66 , 67 ].…”

Myokarditis und COVID-19: Wo stehen wir?

“…Das Management von Patienten mit COVID-19-assoziierter Myokarditis umfasst daher eine rein supportive Therapie bei leichten Verläufen. Besteht jedoch das Vollbild einer fulminanten Myokarditis mit schwerem Verlauf und hämodynamischer Instabilität, sollten die Therapie an einem Schwerpunktzentrum und die Anwendung von mechanischen Kreislaufunterstützungsverfahren (ECMO, Impella [16]) als "Bridge to Recovery" unbedingt in Erwägung gezogen werden.…”