Outcomes Following Lvad Implantation In Covid-19 Patients

Abstract

PurposeEnd-stage heart failure patients are at an increased risk of severe disease and complications from coronavirus disease-2019 (COVID-19). Additionally, the disease increases perioperative risks The purpose of this study was to describe the clinical course following left ventricular assist device (LVAD) implantation in patients with COVID-19.MethodsA single-center, retrospective review between March 2020 and March 2021 identified 6 patients with a history of COVID-19 who subsequently underwent LVAD implantation. Baseline characteristics, clinical course, and outcomes were examined.ResultsPatients were male (83%), Black (67%), and implanted with a Heartmate 3 for destination therapy. The time from COVID-19 diagnosis to LVAD surgery ranged from 3 days to 6 months (median 40 days, [IQR 12-114 days]). All patients were supported with an intra-aortic balloon pump (IABP) and high-dose inotropes prior to implant. The median age was 60 years (IQR 57-61 years) and body mass index 30 kg/m2 (IQR 24-31 kg/m2). Following implantation, 5 patients (83%) had respiratory failure greater than 7 days on ventilator support, 2 (33%) required tracheostomy, and 2 (33%) were reintubated before successful extubation. Two patients (33%) required temporary right ventricular assist device (RVAD) support, 4 patients (67%) needed continuous renal replacement therapy (CRRT), and 3 patients (50%) suffered ischemic strokes: two patients on postoperative day 1, and the other on postoperative day 5. The median length of hospital stay following surgery ranged from 16 to 73 days (median 53 days, [IQR 35-67 days]). Five patients (83%) were discharged from the hospital, 2 to acute inpatient rehab, 1 to a subacute rehabilitation facility, and 2 to home. Two patients (33%) were readmitted within 30 days for gastrointestinal bleeding and neuropathic pain. There was one (17%) 30-day hospital mortality due to multisystem organ failure following a stroke and the decision to withdraw care.