https://doi.org/10.4081/monaldi.2022.2362
Coronavirus disease 2019 and mechanical circulatory support devices: a comprehensive review
Submitted: June 26, 2022
Accepted: August 30, 2022
Published: September 5, 2022
Accepted: August 30, 2022
Abstract Views: 1298
PDF: 445
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Coronavirus disease (COVID-19) can cause circulatory shock refractory to medical therapy. Such patients can be managed with mechanical circulatory support (MCS) devices like IABP, Impella, VA ECMO, and Left Ventricular Assist Devices (LVADs). Moreover, patients on long-term durable LVADs are a special population having increased susceptibility and mortality to COVID-19 infection. In this narrative review, we searched PubMed and Medline for studies on COVID-19 patients on short-term MCS devices. We found 36 papers with 110 patients who met our review criteria, including 89 LVAD patients and 21 COVID-19 patients who needed MCS device therapy. These studies were used to extract patient demographics, clinical presentation, MCS device details, management, and outcomes. Mean age of patients with COVID-19 infection on LVADs was 60, 73% were male, and HeartMate 3 was the most common device (53%). Most patients (77.5%) needed hospitalization, and mortality was 23.6%. Among the 21 reported cases of critically ill COVID-19 patients who required MCS, the mean age was 49.8 years, 52% were women, and the most common MCS device used was VA ECMO (62%) in conjunction with an Impella for LV venting. Comorbidities were not present in 43%, but 71% had abnormal ventricular function on echocardiography. MCS is a viable option for managing severe COVID-19 infection with shock, with many reported cases of favorable outcomes.
World Health Organization. Coronavirus (COVID-19). Available from: https://covid19.who.int
Madjid M, Safavi-Naeini P, Solomon SD, Vardeny O. Potential effects of coronaviruses on the cardiovascular system: A review. JAMA Cardiol 2020;5:831–840.
DOI: https://doi.org/10.1001/jamacardio.2020.1286
Shi S, Qin M, Shen B, et al. Association of Cardiac Injury With Mortality in Hospitalized Patients With COVID-19 in Wuhan, China. JAMA Cardiol 2020;5:802–10.
DOI: https://doi.org/10.1001/jamacardio.2020.0950
John KJ, Mishra AK, Ramasamy C, et al. Heart failure in COVID-19 patients: Critical care experience. World J Virol 2022;11:1–19.
DOI: https://doi.org/10.5501/wjv.v11.i1.1
Tomasoni D, Inciardi RM, Lombardi CM, et al. Impact of heart failure on the clinical course and outcomes of patients hospitalized for COVID‐19. Results of the Cardio‐COVID‐Italy multicentre study. Eur J Heart Fail 2020;22:2238–47.
DOI: https://doi.org/10.1002/ejhf.2052
Maharaj V, Steiner M, Boyle B, et al. Rapidly progressive left ventricular assist device outflow graft thrombosis associated with COVID-19 infection. Circ Heart Failure 2021;14:e008334.
DOI: https://doi.org/10.1161/CIRCHEARTFAILURE.121.008334
Piperata A, Bottio T, Gerosa G. COVID-19 infection in left ventricular assist device patients. J Card Surg 2020;35:3231–4.
DOI: https://doi.org/10.1111/jocs.14969
Özgür MM, Hançer H, Altaş Ö, Kirali K. COVID-19 ARDS in two patients with left ventricular assist device. J Artif Organs 2022;25:148-54.
DOI: https://doi.org/10.1007/s10047-021-01288-y
Arshad S, Unger RE, Birks E. Nosocomial covid-19 infection in an lvad patient. J Am Coll Cardiol 2021;77:3005.
DOI: https://doi.org/10.1016/S0735-1097(21)04360-6
Belfort DS, Biselli B, Brandão SMG, et al. COVID-19 complicating perioperative management of left ventricular assist device implantation. J Heart Lung Transplant 2021;40:S526.
DOI: https://doi.org/10.1016/j.healun.2021.01.2106
Jarrett SA, Alzubi J, Babapoor-Farrokhran S, et al. Left ventricular assist device thrombosis treated with intravenous tissue plasminogen activator in a patient with COVID-19 infection. VAD J 2021;7: e2021716.
Korada SKC, Mann J, Hasan A, et al. Management of COVID-19 in a durable left ventricular assist device recipient: A continuity of care perspective. Heart Lung 2020;49:688–91.
DOI: https://doi.org/10.1016/j.hrtlng.2020.08.012
Hodges K, Mubashir M, Insler J, et al. Successful management of COVID‐19 and associated coagulopathy in a patient with durable left ventricular assist device. J Card Surg 2020;35:3202-4.
DOI: https://doi.org/10.1111/jocs.14937
Frick W, Mallory R, Guglin M, et al. Unusual case of pump thrombosis in LVAD patient with COVID-19 — Diagnostic challenges. VAD J 2020;6:e2020622.
Mahmood K, Rashed ER, Olivares E, et al. Predisposition or protection? COVID-19 in a patient on LVAD support with HIV/AIDS. JACC Case Rep 2020;2:1337–41.
DOI: https://doi.org/10.1016/j.jaccas.2020.05.015
Chau VQ, Oliveros E, Mahmood K, et al. The imperfect cytokine storm: Severe COVID-19 with ARDS in a patient on durable LVAD support. JACC Case Rep 2020;2:1315–20.
DOI: https://doi.org/10.1016/j.jaccas.2020.04.001
Loforte A, Gliozzi G, Suarez SM, Pacini D. Contributory role of positron emission tomography in a left ventricular assist device recipient at the time of COVID-19 pandemic. ASAIO J 2020;66:599–602.
DOI: https://doi.org/10.1097/MAT.0000000000001176
Singh R, Domenico C, Rao SD, et al. Novel coronavirus disease 2019 in a patient on durable left ventricular assist device support. J Card Fail 2020;26:438–9.
DOI: https://doi.org/10.1016/j.cardfail.2020.04.007
Zakrzewski J, Coyle L, Aicher T, et al. Impact of COVID-19 on patients supported with a left ventricular assist device. ASAIO J 2021;67:1189-95.
DOI: https://doi.org/10.1097/MAT.0000000000001578
Birati EY, Najjar SS, Tedford RJ, et al. Characteristics and outcomes of COVID-19 in patients on left ventricular assist device support. Circ Heart Failure 2021;14:e007957.
Sobol I, Yuzefpolskaya M, Roth Z, et al. Characteristics and outcomes of patients with a left ventricular assist device with coronavirus disease-19. J Card Fail 2020;26:895–7.
DOI: https://doi.org/10.1016/j.cardfail.2020.09.011
Cohen GI, Schreiber T, Singh H, Kaki A. Percutaneous thrombectomy and right ventricular mechanical circulatory support for pulmonary embolism in a coronavirus disease 2019 patient: Case report, 1-year update, and echocardiographic findings. Eur Heart J Case Rep 2022;6:ytac008.
DOI: https://doi.org/10.1093/ehjcr/ytac008
Thaker R, Shah A, Kim J, Kassi M. Acute circulatory collapse and advanced therapies in patients with COVID-19 infection. Methodist DeBakey Cardiovasc J 2021;17:43–52.
DOI: https://doi.org/10.14797/mdcvj.1048
Mahrokhian SH, Nordan T, Ortoleva J, et al. Successful use of Impella 5.5 to manage cardiogenic shock complicated by COVID-19. J Card Surg 2021;36:4783-5.
DOI: https://doi.org/10.1111/jocs.16038
Flagiello M, Al Harthy A, Boccalini S, et al. Veno‐arterial extracorporeal membrane oxygenation for COVID‐19‐associated acute myocardial injury complicated by refractory cardiogenic shock. J Card Surg 2021;36:4396–9.
DOI: https://doi.org/10.1111/jocs.15919
Fu Q, Li D, He W, et al. Management of a COVID-19-infected critically ill patient treated by extracorporeal membrane oxygenation: A case report. Ann Palliat Med 2021;10:8490–8.
DOI: https://doi.org/10.21037/apm-20-1176
Sampaio PPN, Ferreira RM, de Albuquerque FN, et al. Rescue venoarterial extracorporeal membrane oxygenation after cardiac arrest in COVID-19 myopericarditis: A case report. Cardiovasc Revasc Med 2021;28 57–60.
DOI: https://doi.org/10.1016/j.carrev.2020.09.038
Luna EAG, Tirado JRB, Castañeda AP. Spontaneous rupture of papillary muscle associated with steroid use in a patient with COVID-19 pneumonia, with a successful outcome to IABP and levosimendam. J Am Coll Cardiol 2021;77:2011.
DOI: https://doi.org/10.1016/S0735-1097(21)03367-2
Ignaszewski M, Pandrangi K, Kabbany M, et al. To VAD or not to VAD: A case of durable left ventricular assist device implantation in a COVID-19 patient. J Heart Lung Transplant 2021;40:S521.
DOI: https://doi.org/10.1016/j.healun.2021.01.2092
Rai D, Anjum Z, Tahir M, et al. ‘Clots and failures’ A case of COVID-19 causing STEMI and persistent cardiogenic shock ultimately requiring LVAD. J Heart Lung Transplant 2021;40:S535.
DOI: https://doi.org/10.1016/j.healun.2021.01.2130
Yeleti R, Guglin M, Saleem K, et al. Fulminant myocarditis: COVID or not COVID? Reinfection or co-infection? Future Cardiol 2021;17:1307–11.
DOI: https://doi.org/10.2217/fca-2020-0237
Ruiz JG, Kandah F, Dhruva P, et al. Case of coronavirus disease 2019 myocarditis managed with biventricular impella support. Cureus 2021;1e13197.
DOI: https://doi.org/10.7759/cureus.13197
Valchanov K, Krishnan U, Hoole SP, et al. COVID-19 patient with coronary thrombosis supported with ECMO and Impella 5.0 ventricular assist device: A case report. Eur Heart J Case Rep 2020;4:1–6.
DOI: https://doi.org/10.1093/ehjcr/ytaa342
Rassaf T, Totzeck M, Mahabadi AA, et al. Ventricular assist device for a coronavirus disease 2019‐affected heart. ESC Heart Failure 2021;8:162–6.
DOI: https://doi.org/10.1002/ehf2.13120
Oliveros E, Mahmood K, Yammine M, et al. Rapid deterioration of hospital-acquired COVID-19 in a patient on extracorporeal left ventricular assist support. Heart Lung 2020;49:808-11.
DOI: https://doi.org/10.1016/j.hrtlng.2020.08.021
Salamanca J, Díez-Villanueva P, Martínez P, et al. COVID-19 ‘fulminant myocarditis’ successfully treated with temporary mechanical circulatory support. JACC Cardiovasc Imaging 2020;13:2457–9.
DOI: https://doi.org/10.1016/j.jcmg.2020.05.003
Byun JH, Kang DH, Kim JW, et al. Veno-arterial-venous extracorporeal membrane oxygenation in a critically ill patient with coronavirus disease 2019. Medicina (Kaunas) 2020;56:510.
DOI: https://doi.org/10.3390/medicina56100510
Akoluk A, Mazahir U, Douedi S, et al. Pulmonary embolism in COVID-19 treated with VA-ECLS and catheter tPA. Clin Med Insights Circ Respir Pulm Med 2020;14:17954842095745.
DOI: https://doi.org/10.1177/1179548420957451
Bemtgen X, Krüger K, Supady A, et al. First Successful treatment of coronavirus disease 2019 induced refractory cardiogenic plus vasoplegic shock by combination of percutaneous ventricular assist device and extracorporeal membrane oxygenation: A case report. ASAIO J 2020;66:607–9.
DOI: https://doi.org/10.1097/MAT.0000000000001178
Fried JA, Ramasubbu K, Bhatt R, et al. The variety of cardiovascular presentations of COVID-19. Circulation 2020;141:1930–6.
DOI: https://doi.org/10.1161/CIRCULATIONAHA.120.047164
Kimball PM, Flattery M, McDougan F, Kasirajan V. Cellular immunity impaired among patients on left ventricular assist device for 6 months. Ann Thorac Surg 2008;85:1656–61.
DOI: https://doi.org/10.1016/j.athoracsur.2008.01.050
Henry BM, Aggarwal G, Wong J, et al. Lactate dehydrogenase levels predict coronavirus disease 2019 (COVID-19) severity and mortality: A pooled analysis. Am J Emerg Med 2020;38:1722–6.
DOI: https://doi.org/10.1016/j.ajem.2020.05.073
Gordon JS, Wood CT, Luc JGY, et al. Clinical implications of LDH isoenzymes in hemolysis and continuous‐flow left ventricular assist device‐induced thrombosis. Artif Organs 2020;44:231–8.
DOI: https://doi.org/10.1111/aor.13565
Hurst TE, Xanthopoulos A, Ehrlinger J, et al. Dynamic prediction of left ventricular assist device pump thrombosis based on lactate dehydrogenase trends. ESC Heart Failure 2019;6:1005–14.
DOI: https://doi.org/10.1002/ehf2.12473
Cho SM, Hassett C, Rice C, et al. What causes LVAD-associated ischemic stroke? Surgery, pump thrombosis, antithrombotics, and infection. Asaio J 2019;65:775–80.
DOI: https://doi.org/10.1097/MAT.0000000000000901
Awad WI, Mohamad Bashir. Mechanical circulatory support-Challenges, strategies, and preparations. J Card Surg 2021;36:1723–8.
DOI: https://doi.org/10.1111/jocs.15301
Houston BA, Kalathiya RJ, Hsu S, et al. Right ventricular afterload sensitivity dramatically increases after left ventricular assist device implantation: A multi-center hemodynamic analysis. J Heart Lung Transplant 2016;35:868–76.
DOI: https://doi.org/10.1016/j.healun.2016.01.1225
Xanthopoulos A, Triposkiadis F, Starling RC. Care for patients with ventricular assist devices and suspected COVID-19 infection. Eur J Heart Fail 2020;22:937–40.
DOI: https://doi.org/10.1002/ejhf.1907
Bravo MJ-B, Gómez JLZ, del Prado Díaz S, Salinas GLA. A suicide attempt on a left ventricular assist device patient during COVID-19 pandemic: Can we only blame the virus? A case report. Eur Heart J Case Rep 2021;5:ytab144.
DOI: https://doi.org/10.1093/ehjcr/ytab144
Roberts KA, Colley L, Agbaedeng TA, et al. Vascular manifestations of COVID-19 – Thromboembolism and microvascular dysfunction. Front Cardiovasc Med 2020;7:598400.
DOI: https://doi.org/10.3389/fcvm.2020.598400
Goldstein DJ, John R, Salerno C, et al. Algorithm for the diagnosis and management of suspected pump thrombus. J Heart Lung Transplant 2013;32:667–70.
DOI: https://doi.org/10.1016/j.healun.2013.05.002
Dang G, Epperla N, Muppidi V, et al. Medical management of pump-related thrombosis in patients with continuous-flow left ventricular assist devices: A systematic review and meta-analysis. ASAIO J 2017;63:373–85.
DOI: https://doi.org/10.1097/MAT.0000000000000497
Reiss N, Schmidt T, Boeckelmann M, et al. Telemonitoring of left-ventricular assist device patients—current status and future challenges. J Thorac Dis 2018;10:S1794-801.
DOI: https://doi.org/10.21037/jtd.2018.01.158
Abraham WT, Adamson PB, Bourge RC, et al. Wireless pulmonary artery haemodynamic monitoring in chronic heart failure: A randomised controlled trial. Lancet 2011;377:658–66.
DOI: https://doi.org/10.1016/S0140-6736(11)60101-3
Schmidt T, Mewes P, Hoffmann J-D, et al. Improved aftercare in LVAD patients: Development and feasibility of a smartphone application as a first step for telemonitoring. Artif Organs 2020;44:248–56.
DOI: https://doi.org/10.1111/aor.13560
Hohmann S, Veltmann C, Duncker D, et al. Initial experience with telemonitoring in left ventricular assist device patients. J Thorac Dis 2019;11:S853-63.
DOI: https://doi.org/10.21037/jtd.2018.10.37
Combes A, Price S, Slutsky AS, Brodie D. Temporary circulatory support for cardiogenic shock. Lancet 2020;396:199–212.
DOI: https://doi.org/10.1016/S0140-6736(20)31047-3
Ouweneel DM, Schotborgh JV, Limpens J, et al. Extracorporeal life support during cardiac arrest and cardiogenic shock: A systematic review and meta-analysis. Intensive Care Med 2016;42:1922–34.
DOI: https://doi.org/10.1007/s00134-016-4536-8
Thiele H, Sick P, Boudriot E, et al. Randomized comparison of intra-aortic balloon support with a percutaneous left ventricular assist device in patients with revascularized acute myocardial infarction complicated by cardiogenic shock. Eur Heart J 2005;26:1276–83.
DOI: https://doi.org/10.1093/eurheartj/ehi161
Pappalardo F, Schulte C, Pieri M, et al. Concomitant implantation of Impella® on top of veno-arterial extracorporeal membrane oxygenation may improve survival of patients with cardiogenic shock. Eur J Heart Fail 2017;19:404–12.
DOI: https://doi.org/10.1002/ejhf.668
de Pommereau A, Radu C, Boukantar M, et al. Left ventricle unloading through pulmonary artery in patients with venoarterial extracorporeal membrane oxygenation. ASAIO J 2021;67:e49–e51.
DOI: https://doi.org/10.1097/MAT.0000000000001179
Donker DW, Brodie D, Henriques JPS, Broomé M. Left ventricular unloading during veno-arterial ECMO: A simulation study. ASAIO J 2019;65:11–20.
DOI: https://doi.org/10.1097/MAT.0000000000000755
Badulak J, Antonini MV, Stead CM, et al. Extracorporeal membrane oxygenation for COVID-19: Updated 2021 Guidelines from the Extracorporeal Life Support Organization. ASAIO J 2021;67:485–95.
DOI: https://doi.org/10.1097/MAT.0000000000001422
Lorusso R, Shekar K, MacLaren G, et al. ELSO interim guidelines for venoarterial extracorporeal membrane oxygenation in adult cardiac patients. ASAIO J 2021;67:827-44.
DOI: https://doi.org/10.1097/MAT.0000000000001510
Schmidt M, Burrell A, Roberts L, et al. Predicting survival after ECMO for refractory cardiogenic shock: The survival after veno-arterial-ECMO (SAVE)-score. Eur Heart J 2015;36:2246–56.
DOI: https://doi.org/10.1093/eurheartj/ehv194
Muller G, Flecher E, Lebreton G, et al. The ENCOURAGE mortality risk score and analysis of long-term outcomes after VA-ECMO for acute myocardial infarction with cardiogenic shock. Intensive Care Med 2016;42:370–8.
DOI: https://doi.org/10.1007/s00134-016-4223-9
Wang L, Yang F, Wang X, et al. Predicting mortality in patients undergoing VA-ECMO after coronary artery bypass grafting: The REMEMBER score. Crit Care 2019;23:11.
DOI: https://doi.org/10.1186/s13054-019-2307-y
Sánchez-Salado JC, Lorente V, Alegre O, et al. Predictive ability of the CardShock score in patients with profound cardiogenic shock undergoing venoarterial extracorporeal membrane oxygenation support. Med Intensiva 2020;44:312–5
DOI: https://doi.org/10.1016/j.medine.2019.11.004
Extracorporeal Life Support Organization [Internet]. Registry Dashboard of ECMO-Supported COVID-19 Patient Data. Available from: https://www.elso.org/Registry/FullCOVID-19RegistryDashboard.aspx
Lorusso R, Combes A, Lo Coco V, et al. ECMO for COVID-19 patients in Europe and Israel. Intensive Care Med 2021;47:344–8.
DOI: https://doi.org/10.1007/s00134-020-06272-3
Barbaro RP, MacLaren G, Boonstra PS, et al. Extracorporeal membrane oxygenation support in COVID-19: An international cohort study of the Extracorporeal Life Support Organization registry. Lancet 2020;396:1071–8.
DOI: https://doi.org/10.1016/S0140-6736(20)32008-0
Schmidt M, Hajage D, Lebreton G, et al. Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome associated with COVID-19: A retrospective cohort study. Lancet Respir Med 2020;8:1121–31.
DOI: https://doi.org/10.1016/S2213-2600(20)30328-3
Mariani S, De Piero ME, Ravaux JM, et al. Temporary mechanical circulatory support for COVID‐19 patients: A systematic review of literature. Artif Organs 2022;46:1249–67.
DOI: https://doi.org/10.1111/aor.14261
De Piero ME, Lo Coco V, Taccone FS, et al. Has venoarterial ECMO been underutilized in COVID-19 patients? Innovations (Phila) 2020;15:317–21.
DOI: https://doi.org/10.1177/1556984520939076
Yastrebov K, Brunel L, Paterson HS, et al. Intracardiac echocardiography for point-of-care guided left ventricular assist device implantation: Surgical implications for COVID-19. Surg Innov 2022;29:292–4.
DOI: https://doi.org/10.1177/15533506211037787
Cain MT, Smith NJ, Barash M, et al. Extracorporeal membrane oxygenation with right ventricular assist device for COVID-19 ARDS. J Surg Res 2021;264:81–9.
DOI: https://doi.org/10.1016/j.jss.2021.03.017
How to Cite
John, Kevin, Ajay Kumar Mishra, Jemimah Nayar, Jordy Mehawej, and Amos Lal. 2022. “Coronavirus Disease 2019 and Mechanical Circulatory Support Devices: A Comprehensive Review”. Monaldi Archives for Chest Disease 93 (2). https://doi.org/10.4081/monaldi.2022.2362.
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