COVID-19 in patients with left ventricular assist device

Abstract

Background. Coronavirus infection (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Patients with cardiovascular disease especially patients with advanced heart failure are at particularly high risk of morbidity and mortality. Patients with left ventricular assist device (LVAD) represent a unique population at risk because of comorbidities and functionally compromised immunity. Аim of this article was to analyze clinical cases of COVID-19 among LVAD patients of the Republic of Kazakhstan. Material and methods. Characteristics of LVAD patients of the Republic of Kazakhstan who developed COVID-19 between March 2020 and August 2021, initial manifestations of the disease, comorbidities, complications and clinical outcomes were collected and analyzed. Results. A total of 177 patients with LVAD who were supported and registered by the NAO “National Scientific Cardiac Surgery Center” were interviewed. 41 (23.2%) patients had classic COVID-19 symptoms. The mean age of the patients was 55 years (interquartile range, 17-75), and 9 (21.9%) patients were female. The majority of patients (n=36, 87.8%) were implanted with LVAD HeartMate 3. The largest number, 19 (46%) patients, were patients with dilated cardiomyopathy (DCM). The time of LVAD support ranged from 1 month to 83 months before the onset of symptoms and diagnosis of COVID-19. 13 (31.7%) patients required hospitalization due to decreased oxygen saturation (less than 94%) and oxygen deprivation. 3 patients (1.7% among 177 supported patients and 7.3% among patients with COVID-19) required care and treatment in an intensive care unit. Conclusion. We presented an analysis of clinical cases in LVAD patients with COVID-19 in Kazakhstan. To note, there are no guidelines for management and treatment, no data related to the clinical course of COVID-19 in patients on LVAD support to date. Close monitoring of clinical status, anticoagulation and frequent collection of device parameters and DL exit site images, precautionary measures consideration, early diagnosis, timely initiated treatment, supportive psychological care, multidisciplinary approach and rigorous follow-up are crucial in the management of LVAD patients with COVID-19.