ABSTRACT
Introduction The management of patients with heart failure who contract COVID-19 and those who develop heart failure as a consequence of the disease is challenging. The use of advanced therapies in the form of durable left ventricular assist device or heart transplant in this patient population remains a data free zone. We present, to our knowledge, the first case of durable LVAD implantation in a recovered COVID-19 patient. Case Report A 63-year old, previously healthy, male was admitted to OSH with COVID-19 pneumonia and acute respiratory distress syndrome requiring prolonged mechanical ventilation. This hospitalization was complicated by anterior STEMI, cardiomyopathy with severe LV dysfunction and cardiogenic shock. Due to widespread COVID-19 pandemic, invasive evaluation was deferred and the patient was medically managed. He was then transferred to our institution after re-admission for recurrent cardiogenic shock. Echocardiogram revealed dilated LV cavity (6.3 cm), LVEF 10% and large apical aneurysm. Chest CT showed sequelae of prior COVID-19 with changes suggestive of fibrosis. CMR which showed LV dilatation, severe LV systolic dysfunction, LVEF 7% and large apical aneurysm with evidence of thrombus. A large transmural infarct in the LAD territory without viability was confirmed. Cardiogenic shock was managed with Dobutamine and attempts to wean inotrope resulted in worsening hemodynamic and clinical profile. Axillary IABP was placed to facilitate physical and respiratory rehabilitation. The patient underwent placement of HeartMate™ 3 device as DT and LV aneurysm repair. Post-operative course was uneventful and he was ultimately discharged to acute rehabilitation in stable condition. Summary As the global case rate continues to climb and the threat of an exponential surge of long-term cardiac complications looms in the not so distant future, the use of durable MCS in recovered COVID-19 patients may evolve. This case highlights LVAD as a feasible option in end-stage HF and emphasizes the importance of a multidisciplinary approach in assessing candidacy for advanced HF therapies in post-COVID-19 patients. Continued international collaboration and further study regarding use of MCS will be paramount in optimizing care and outcomes in this growing patient population.