Successful utilization of nirmatrelvir/ritonavir and dexamethasone in a patient with total artificial heart and COVID-19: A case report

Abstract

Rationale: Management of coronavirus disease 2019 (COVID-19) has been the subject of extensive research and study, leading to the development of strategies and treatments. Nonetheless, there remains a dearth of information concerning patients who require mechanical circulatory system support. This case report presents one of the first documented cases of successful utilization of nirmatrelvir/ritonavir (Paxlovid) and dexamethasone in the treatment of a patient with a total artificial heart.

Patient concerns: The patient in this case study was a 28-year-old male who had been experiencing severe heart failure. In need of a heart transplant, he underwent a procedure for implantation of a total artificial heart as a bridge to transplantation.

Diagnoses: Unfortunately, after the surgical intervention, the patient contracted COVID-19, as confirmed by polymerase chain reaction.

Interventions: The therapeutic approach involved a 5-day regimen of nirmatrelvir/ritonavir at a dosage of 300/100 mg administered twice daily, along with a daily dosage of 6 mg of dexamethasone.

Outcomes: Remarkably, the patient oxygenation level improved on the second day of therapy. Consequently, he was transferred from the intensive care unit to the general floor. After 71 days with the total artificial heart, the patient successfully underwent heart transplantation.

Lessons: This case report provides a compelling example of the successful application of nirmatrelvir/ritonavir and dexamethasone in the treatment of a COVID-19 patient with a total artificial heart. The positive outcome observed in this case underscores the potential use of these therapeutic agents in this specific patient population. However, it is imperative to conduct further research to corroborate and validate these initial findings. This study lays the foundation for further exploration of the efficacy of these drugs in patients with mechanical circulatory support systems.

Figure 1.

The most relevant chest X-rays during his course of management; (A) Chest X-ray on the day of admission, d 1, February 25, 2023. (B) Chest X-ray just prior to TAH implantation while the patient was on V-A ECMO, d 14, March 10, 2023. (C) Chest X-ray day post TAH implantation, d 15, March 11, 2023. (D) Chest X-ray 1 wk after initiation of Paxlovid therapy; d 24, March 20, 2023.

Figure 2.

Chronological overview of events and interventions from the point of hospital admission to the heart transplant procedure.