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Mechanical circulatory support-Challenges, strategies, and preparations.
1Department of Cardiothoracic Surgey, Barts Heart Centre, St Bartholomew's Hospital, London, UK.
Journal of Cardiac Surgery
|January 14, 2021
Summary
The COVID-19 pandemic presents challenges for heart failure (HF) patients requiring mechanical circulatory support. Management strategies must adapt, reserving advanced interventions like ECMO for severe cases and considering remote care for LVAD patients.
Area of Science:
- Cardiology
- Infectious Diseases
- Critical Care Medicine
Background:
- Coronavirus disease 2019 (COVID-19) can lead to severe respiratory and cardiovascular complications.
- Patients with pre-existing heart failure (HF) are at increased risk during the COVID-19 pandemic.
- Cardiovascular involvement is a significant concern in COVID-19 patients.
Purpose of the Study:
- To review the challenges in managing patients with heart failure (HF) on mechanical circulatory support during the COVID-19 pandemic.
- To examine available mechanical circulatory support (MCS) strategies for HF patients amidst the pandemic.
Main Methods:
- Literature review of challenges and management strategies for HF patients with MCS during COVID-19.
- Analysis of the application of extracorporeal membrane oxygenation (ECMO), Impella RP, and ventricular assist devices (VADs).
Main Results:
- Extracorporeal membrane oxygenation (ECMO) is a critical option for severe ARDS or refractory circulatory compromise.
- Impella RP offers right ventricular support for COVID-19-induced failure, including pulmonary embolism complications.
- Left ventricular assist device (LVAD) implantation criteria have tightened (INTERMACS 1-2), with a rise in remote patient monitoring and virtual care.
Conclusions:
- COVID-19 is expected to increase the incidence and prevalence of heart failure (HF), necessitating special care.
- ECMO should be reserved for carefully selected COVID-19 patients with a good prognosis.
- Advanced HF patients, including those with durable LVADs, require tailored management strategies during and after the pandemic.
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