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Alotaibi K, Bakhsh A, Alkhaf F, Amro A, Albarrak M, Tantawy T, Arafat AA, Adam AI. Myocardial recovery in a patient with dilated cardiomyopathy after short-term biventricular assist device support. J Card Surg 2022; 37:5591-5594. [PMID: 36378911 DOI: 10.1111/jocs.17148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 10/27/2022] [Indexed: 11/16/2022]
Abstract
Management of patients with end-stage heart failure is still challenging. We report a case of idiopathic dilated cardiomyopathy who went through a challenging course. The case was presented as acute heart failure syndrome, which rapidly declined into cardiogenic shock and cardiac arrest that required an extracorporeal membrane oxygenator, then biventricular assist device implantation for circulatory support. The course was complicated with severe gastrointestinal bleeding and multiorgan failure until achieving full cardiac and organ recovery. The left ventricle ejection fraction improved from 10% to 50% at discharge.
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Affiliation(s)
- Khaled Alotaibi
- Adult Cardiac Surgery Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Abeer Bakhsh
- Adult Cardiology Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Fahmi Alkhaf
- Adult Cardiology Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Ahmed Amro
- Adult Cardiology Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Mohammad Albarrak
- Cardiac Intensive Care Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Tarek Tantawy
- Cardiac Intensive Care Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia.,Critical Care Medicine Department, Cairo University, Cairo, Egypt
| | - Amr A Arafat
- Adult Cardiac Surgery Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia.,Cardiothoracic Surgery Department, Tanta University, Tanta, Egypt
| | - Adam I Adam
- Adult Cardiac Surgery Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
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John K, Mishra AK, Nayar J, Mehawej J, Lal A. Coronavirus disease 2019 and mechanical circulatory support devices: a comprehensive review. Monaldi Arch Chest Dis 2022; 93. [PMID: 36063088 DOI: 10.4081/monaldi.2022.2362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 08/30/2022] [Indexed: 11/22/2022] Open
Abstract
Coronavirus disease (COVID-19) can cause circulatory shock refractory to medical therapy. Such patients can be managed with mechanical circulatory support (MCS) devices like IABP, Impella, VA ECMO, and Left Ventricular Assist Devices (LVADs). Moreover, patients on long-term durable LVADs are a special population having increased susceptibility and mortality to COVID-19 infection. In this narrative review, we searched PubMed and Medline for studies on COVID-19 patients on short-term MCS devices. We found 36 papers with 110 patients who met our review criteria, including 89 LVAD patients and 21 COVID-19 patients who needed MCS device therapy. These studies were used to extract patient demographics, clinical presentation, MCS device details, management, and outcomes. Mean age of patients with COVID-19 infection on LVADs was 60, 73% were male, and HeartMate 3 was the most common device (53%). Most patients (77.5%) needed hospitalization, and mortality was 23.6%. Among the 21 reported cases of critically ill COVID-19 patients who required MCS, the mean age was 49.8 years, 52% were women, and the most common MCS device used was VA ECMO (62%) in conjunction with an Impella for LV venting. Comorbidities were not present in 43%, but 71% had abnormal ventricular function on echocardiography. MCS is a viable option for managing severe COVID-19 infection with shock, with many reported cases of favorable outcomes.
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Affiliation(s)
- Kevin John
- Department of Critical Care, Believers Church Medical College Hospital, Thiruvalla, Kerala.
| | | | - Jemimah Nayar
- Department of Nuclear Medicine, Christian Medical College, Vellore.
| | - Jordy Mehawej
- Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, MA.
| | - Amos Lal
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Multidisciplinary Epidemiology and Translational Research in Intensive Care Group, Mayo Clinic, Rochester, MN.
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3
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Outcomes of patients with left ventricular assist device infected with SARS-CoV-2. TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2022; 30:199-205. [PMID: 36168583 PMCID: PMC9473599 DOI: 10.5606/tgkdc.dergisi.2022.23414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 04/19/2022] [Indexed: 12/15/2022]
Abstract
Background
The aim of this study was to describe clinical characteristics, course, and outcomes of the novel coronavirus disease 2019 (COVID-19) in heart failure patients with left ventricular assist device.
Methods
Between November 2020 and August 2021, a total of 20 patients (18 males, 2 females; mean age: 57.0+10.0 years; range, 30 to 71 years) with left ventricular assist device and who were diagnosed by the COVID-19 polymerase chain reaction testing were included. For each patient, disease-related factors were evaluated including presence of hospitalization, home quarantine, presence of lung damage, antiviral medication strategy, symptomatology and complications following COVID-19.
Results
Seven patients 35% patients died in our cohort following the COVID-19. All these patients experienced variety of complications following COVID-19 including subarachnoid hemorrhage and right heart failure. Three patients were already hospitalized due to COVID-19 and decompensated progressively, resulting in death on Days 14, 4, and 7 after the initial diagnosis.
Conclusion
COVID-19 seems to be an important cause of mortality in patients with LVAD who have borderline cardiopulmonary function. Great care should be taken to avoid interruption in routine follow-ups with these patients, since they present a more sensitive population.
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Management of Patients with Left Ventricular Assist Device during the COVID-19 Pandemic. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58010116. [PMID: 35056424 PMCID: PMC8781665 DOI: 10.3390/medicina58010116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/08/2022] [Accepted: 01/10/2022] [Indexed: 11/17/2022]
Abstract
The novel coronavirus disease 2019 (COVID-19) is an infectious disease with multi-organ involvement, including the cardiovascular system. The disease may cause several cardiovascular complications, and may increase morbidity and mortality among patients with background cardiovascular disease. Patients with advanced heart failure are often treated with left ventricular assist device (LVAD), and represent a unique population mandating multi-disciplinary approach. Several aspects of COVID-19 should be taken into account in LVAD implants, including right ventricular involvement, hemodynamic alterations, thromboembolic and haemorrhagic complications, and the psychological effects of social isolation. Patients with VAD and suspected COVID-19 should be transferred to specialized centers for better management of complications. Here, we review the implications of COVID-19 pandemic on LVAD patients with our recommendations for appropriate management.
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Maharaj V, Steiner M, Boyle B, Kazmirczak F, Markowitz J, Alexy T, Shaffer A, John R, Martin CM, Cogswell R, Kamdar F. Rapidly Progressive Left Ventricular Assist Device Outflow Graft Thrombosis Associated With COVID-19 Infection. Circ Heart Fail 2021; 14:e008334. [PMID: 34775782 DOI: 10.1161/circheartfailure.121.008334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Valmiki Maharaj
- Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis. (V.M., B.B., F. Kazmirczak, J.M., T.A., C.M.M., R.C., F. Kamdar)
| | - Marie Steiner
- Divisions of Hematology and Oncology and Critical Care, University of Minnesota, Minneapolis. (M.S.)
| | - Brenden Boyle
- Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis. (V.M., B.B., F. Kazmirczak, J.M., T.A., C.M.M., R.C., F. Kamdar)
| | - Felipe Kazmirczak
- Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis. (V.M., B.B., F. Kazmirczak, J.M., T.A., C.M.M., R.C., F. Kamdar)
| | - Jeremy Markowitz
- Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis. (V.M., B.B., F. Kazmirczak, J.M., T.A., C.M.M., R.C., F. Kamdar)
| | - Tamas Alexy
- Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis. (V.M., B.B., F. Kazmirczak, J.M., T.A., C.M.M., R.C., F. Kamdar)
| | - Andrew Shaffer
- Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota, Minneapolis. (A.S., R.J.)
| | - Ranjit John
- Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota, Minneapolis. (A.S., R.J.)
| | - Cindy M Martin
- Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis. (V.M., B.B., F. Kazmirczak, J.M., T.A., C.M.M., R.C., F. Kamdar)
| | - Rebecca Cogswell
- Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis. (V.M., B.B., F. Kazmirczak, J.M., T.A., C.M.M., R.C., F. Kamdar)
| | - Forum Kamdar
- Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis. (V.M., B.B., F. Kazmirczak, J.M., T.A., C.M.M., R.C., F. Kamdar)
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Zakrzewski J, Coyle L, Aicher T, Chickerillo K, Gallagher C, Kuper K, Sciamanna C, Chau VQ, Tatooles A. Impact of COVID-19 on Patients Supported with a Left Ventricular Assist Device. ASAIO J 2021; 67:1189-1195. [PMID: 34475334 PMCID: PMC8555883 DOI: 10.1097/mat.0000000000001578] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Patients on left ventricular assist device (LVAD) support may be susceptible to severe disease and complications from coronavirus disease-19 (COVID-19). The purpose of this study was to describe the clinical course of COVID-19 in LVAD patients. A retrospective review was performed at our center; 28 LVAD patients who developed COVID-19 between March 2020 and March 2021, and six patients with a prior COVID-19 infection who underwent LVAD implantation, were identified and examined. Of the 28 patients, nine (32%) died during the study period, five (18%) during their index hospitalization for COVID-19. Two patients (7%) presented with suspected pump thrombosis. In a nonadjusted binary regression logistic analysis, admission to the intensive care unit (unadjusted odds ratio, 7.6 [CI, 1.2-48], P = 0.03), and the need for mechanical ventilation (unadjusted odds ratio 14 [CI, 1.3-159], P = 0.03) were associated with mortality. The six patients who previously had COVID-19 and subsequently received a LVAD were on intra-aortic balloon pump and inotropic support at time of surgery. All six experienced a complicated and prolonged postoperative course. Three patients (50%) suffered from ischemic stroke, and there was one (17%) 30 day mortality. We observed an increased risk of morbidity and mortality in LVAD patients with COVID-19.
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Affiliation(s)
- Jack Zakrzewski
- From the Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Laura Coyle
- Advocate Heart Institute, Advocate Christ Medical Center, Oak Lawn, Illinois
| | - Tracy Aicher
- Advocate Heart Institute, Advocate Christ Medical Center, Oak Lawn, Illinois
| | | | - Colleen Gallagher
- Advocate Heart Institute, Advocate Christ Medical Center, Oak Lawn, Illinois
| | - Katelyn Kuper
- Advocate Heart Institute, Advocate Christ Medical Center, Oak Lawn, Illinois
| | - Chris Sciamanna
- Advocate Heart Institute, Advocate Christ Medical Center, Oak Lawn, Illinois
| | - Vinh Q. Chau
- Advocate Heart Institute, Advocate Christ Medical Center, Oak Lawn, Illinois
| | - Antone Tatooles
- Advocate Heart Institute, Advocate Christ Medical Center, Oak Lawn, Illinois
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Belfort DDSP, Biselli B, Ávila MS, Lira MTSDS, Galas FRBG, Steffen SP, Gaiotto FA, Jatene FB, Bocchi EA, Ferreira SMA. COVID-19 complicating perioperative management of LVAD implantation: A case report and systematic review. J Card Surg 2021; 36:3405-3409. [PMID: 34091934 PMCID: PMC8242914 DOI: 10.1111/jocs.15690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/14/2021] [Accepted: 05/23/2021] [Indexed: 01/05/2023]
Abstract
The coronavirus 2019 disease (COVID-19) affected 125 million people worldwide and caused 2.7 million deaths. Some comorbidities are associated with worse prognosis and left ventricular assist device (LVAD) recipients are probably part of this high-risk population. We report a 31-year-old male patient who developed COVID-19 during LVAD implantation. His postoperative period was complicated by severe pneumonia and mechanical ventilation (MV) leading to right ventricular failure (RVF) and inotrope necessity. He experienced multiple complications, but eventually recovered. We present a systematic review of LVAD recipients and COVID-19. Among 14 patients, the mean age was 62.7 years, 78.5% were male. A total of 5 patients (35.7%) required MV and 3 patients (21.4%) died. A total of 2 patients (14.2%) had thromboembolic events. This case and systematic review suggest LVAD recipients are at particular risk of unfavorable outcomes and they may be more susceptible to RVF in the setting of COVID-19, particularly during perioperative period.
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Affiliation(s)
- Deborah de Sá Pereira Belfort
- Department of Heart Failure, Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de MedicinaUniversidade de São PauloSão PauloBrazil
| | - Bruno Biselli
- Department of Heart Failure, Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de MedicinaUniversidade de São PauloSão PauloBrazil
| | - Mônica Samuel Ávila
- Department of Heart Failure, Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de MedicinaUniversidade de São PauloSão PauloBrazil
| | - Maria Tereza Sampaio de Sousa Lira
- Department of Heart Failure, Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de MedicinaUniversidade de São PauloSão PauloBrazil
| | - Filomena Regina Barbosa Gomes Galas
- Department of Heart Failure, Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de MedicinaUniversidade de São PauloSão PauloBrazil
| | - Samuel Padovani Steffen
- Department of Heart Failure, Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de MedicinaUniversidade de São PauloSão PauloBrazil
| | - Fabio Antonio Gaiotto
- Department of Heart Failure, Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de MedicinaUniversidade de São PauloSão PauloBrazil
| | - Fabio Biscegli Jatene
- Department of Heart Failure, Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de MedicinaUniversidade de São PauloSão PauloBrazil
| | - Edimar Alcides Bocchi
- Department of Heart Failure, Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de MedicinaUniversidade de São PauloSão PauloBrazil
| | - Silvia Moreira Ayub Ferreira
- Department of Heart Failure, Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de MedicinaUniversidade de São PauloSão PauloBrazil
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Telemonitoring and Care Program for Left Ventricular Assist Device Patients During COVID-19 Outbreak: A European Experience. ASAIO J 2021; 67:973-981. [PMID: 34403376 DOI: 10.1097/mat.0000000000001526] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) radically modified the organization of healthcare systems with shutdown of routine activities and outpatient clinics. Herein, we report our institutional experience with a Telemonitoring and Care Program (TC-Program) to monitor and support left ventricular assist device (LVAD) patients during COVID-19 outbreak. This single-arm cohort study analyzed 156 patients who entered the TC-Program at our institution between April and August 2020. The TC-Program was based on routine phone calls to patients and a 24/7 emergency line. In November 2020, patients were asked for feedback on the TC-Program and checked for survival, transplant, or explant. The primary endpoint was the rate of TC-Program-driven interventions. Patients (males: 82.8%) were 61 years old (interquartile range [IQR]: 53.0-67.5) and on LVAD support for 1,266 days (IQR: 475-2,211). Patients were included in the TC-Program for a median time of 99 days (min:15, max:120) and received a median number of six phone calls (min:1, max:14). Twenty-three patients (14.7%) were referred for clinical evaluation after phone contact. Two patients (1.27%) were diagnosed with COVID-19: one of them died after intensive care, and one remained paucisymptomatic and recovered. Three patients asked to exit the program considering it not useful while the others gave high rates in terms of usefulness (median: 9, IQR: 8-10), information (median: 9, IQR: 8-10), good medical care (median: 9, IQR: 8-10), and psychologic support (median: 8, IQR: 7-10). A TC-Program based on the four ICSA principles (Inform, Care, Support, and Adapt) is feasible in LVAD patients and can be rapidly implemented during the COVID-19 pandemic.
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Piperata A, Bottio T, Gerosa G. COVID-19 infection in left ventricular assist device patients. J Card Surg 2020; 35:3231-3234. [PMID: 32827186 PMCID: PMC7461322 DOI: 10.1111/jocs.14969] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/23/2020] [Accepted: 08/11/2020] [Indexed: 01/19/2023]
Abstract
We describe two cases of favorable and unexpected recovery in positive patients with coronavirus disease 2019, suffering from multiorgan comorbidity and already assisted with the left ventricular assist device. We have observed that, although in the presence of more comorbidities, when the maintenance of a valid support of the cardiovascular function is guaranteed, the possibility of successfully overcoming the severe acute respiratory syndrome coronavirus 2 infection is still alive.
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Affiliation(s)
- Antonio Piperata
- Department of Cardiac, Thoracic, Vascular, and Public Health Sciences, University of Padua, Padova, Italy
| | - Tomaso Bottio
- Department of Cardiac, Thoracic, Vascular, and Public Health Sciences, University of Padua, Padova, Italy
| | - Gino Gerosa
- Department of Cardiac, Thoracic, Vascular, and Public Health Sciences, University of Padua, Padova, Italy
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