COVID-19 complicating perioperative management of LVAD implantation: A case report and systematic review

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.

Keywords: COVID-19; LVAD; acute respiratory distress syndrome; right ventricular dysfunction.

Figure 1

(A) Thoracic computed tomography (CT) scan on admission revealing consolidation on right lung. (B) Thoracic CT scan on postoperative Day 34 revealing multiple ground glass opacities, diffuse consolidations and moderate bilateral pneumothorax

Figure 2

Chest radiography on postoperative Day 5 revealing multiple bilateral opacities