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Accelerated LVAD pump thrombosis in COVID-19 patient: Case report and mini review
Ishaq J Wadiwala1, Pankaj Garg2, Mohammad Alomari1
1Department of Cardiothoracic Surgery Research Unit, Mayo Clinic, Jacksonville, Florida, USA.
Insights
Coronavirus (COVID-19) infection increases mortality risk in patients with left ventricular assist devices (LVADs). COVID-19 exacerbates LVAD thrombosis, leading to worse outcomes and higher death rates in heart failure patients.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Devices
Background:
- Heart failure patients on mechanical support face elevated risks from COVID-19.
- Left ventricular assist devices (LVADs) are critical for advanced heart failure management.
- Understanding COVID-19's impact on LVAD complications is crucial for patient care.
Observation:
- A review of medical records identified cases of LVAD thrombosis with and without COVID-19 infection.
- Patients experiencing LVAD thrombosis alongside COVID-19 showed more severe presentations.
- A comparison revealed a higher mortality rate in LVAD thrombosis patients with COVID-19 (3 deaths) versus those without (1 death).
Findings:
- COVID-19 infection significantly increases the risk of mortality in LVAD patients.
- The virus accelerates pump thrombosis through elevated procoagulant factors.
- LVAD thrombosis, exacerbated by COVID-19, leads to severe complications including hemodynamic instability and hemolysis.
Implications:
- COVID-19 poses a substantial threat to LVAD recipients, increasing morbidity and mortality.
- Prothrombotic conditions induced by COVID-19 worsen LVAD thrombosis outcomes.
- Further research and clinical vigilance are needed to mitigate risks for this vulnerable patient population.
Background:
Coronavirus (COVID-19) infection exposes patients with heart failure specially who are on mechanical support to a higher risk of morbidity and mortality.
Aims:
To investigate the impact of COVID-19 infection on left ventricular assist device (LVAD) thrombosis in heart failure patients.
Materials & Methods:
We searched the medical electronic records, Medline, PubMed and Cochrane databases for; (LVAD) AND (thrombosis)) AND (covid-19)) AND (heart failure). We divided cases reported into, LVAD thrombosis with COVID-19 infection and compare them with LVAD thrombosis without COVID-19 infection. Demographic data, LVAD device, presentation, treatment and outcomes were reviewed in all the LVAD thrombosis patients.
Results:
In addition to our case, 8 other cases of LVAD thrombosis associated with COVID and 9 cases of LVAD thrombosis without covid infection were found. Patients with Covid infection had worse presentation and outcomes (3 deaths VS. 1 death in non-covid group).
Discussion:
In LVAD patients, pump malfunction due to thrombus development in the inflow cannula, device body, or outflow graft can result in hemodynamic instability, hemolysis and other life-threatening complications. COVID infection significantly increases the risk of mortality in LVAD patient by accelerating the pump thrombosis due to elevated levels of endothelial protein C receptor and thrombomodulin along with procoagulants such as factor VIII, P-selectin, and von Willebrand factor.
Conclusion:
Significant morbidity and mortality are attributed to LVAD thrombosis, which are exasperated by prothrombotic conditions created in COVID-19 infections.
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