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Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
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Coronavirus disease 2019 and mechanical circulatory support devices: a comprehensive review

Kevin John1, Ajay Kumar Mishra2, Jemimah Nayar3

  • 1Department of Critical Care, Believers Church Medical College Hospital, Thiruvalla, Kerala. kevinjohn619@gmail.com.

Monaldi Archives for Chest Disease = Archivio Monaldi Per Le Malattie Del Torace
|September 5, 2022
PubMed

Insights

Mechanical circulatory support (MCS) devices can manage severe COVID-19 shock. Patients with Left Ventricular Assist Devices (LVADs) and COVID-19 face higher risks, but MCS offers a viable treatment option with favorable outcomes.

Area of Science:

  • Cardiology and Critical Care Medicine
  • Infectious Diseases

Background:

  • Coronavirus disease (COVID-19) can lead to refractory circulatory shock, necessitating advanced interventions.
  • Patients with pre-existing mechanical circulatory support (MCS) devices, particularly durable Left Ventricular Assist Devices (LVADs), represent a vulnerable population with increased COVID-19 susceptibility and mortality.
  • The management of COVID-19 patients requiring MCS, especially those with LVADs, presents unique clinical challenges.

Approach:

  • A narrative review was conducted, systematically searching PubMed and Medline databases for studies involving COVID-19 patients managed with short-term MCS devices.
  • Data extraction focused on patient demographics, clinical presentation, specific MCS device details, treatment strategies, and patient outcomes.
  • Analysis included 110 patients from 36 papers, comprising 89 patients with LVADs and COVID-19, and 21 critically ill COVID-19 patients requiring new MCS therapy.

Key Points:

  • In patients with COVID-19 and LVADs, the mean age was 60, 73% were male, and the HeartMate 3 was the most common device (53%). Hospitalization was required for 77.5%, with a 23.6% mortality rate.
  • For critically ill COVID-19 patients needing MCS, the mean age was 49.8 years, 52% were female, and VA ECMO combined with an Impella for LV venting was the most frequent approach (62%).
  • A significant proportion (71%) of these critically ill patients exhibited abnormal ventricular function on echocardiography, despite 43% having no comorbidities.

Conclusions:

  • Mechanical circulatory support (MCS) is a feasible and effective therapeutic option for patients experiencing severe COVID-19 infection complicated by circulatory shock.
  • The review highlights the potential for favorable outcomes in carefully selected patients requiring MCS for COVID-19-related circulatory compromise.
  • Further research into optimal MCS strategies for COVID-19 patients, particularly those with underlying cardiac conditions or LVADs, is warranted.

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