COVID-19 in Patients with a Ventricular Assist Device

Background: Within the scope of the ongoing COVID-19 pandemic, risk assessment and adequate therapy for patients on VAD support remain problematic. The aim of this study was to describe the clinical presentation of COVID-19 in patients on VAD and share the experience we have had during the first year of the pandemic.

Method: Retrospective analysis of adult patients on VAD support at the German Heart Center Berlin with a laboratory-confirmed SARS-CoV-2 infection. Of 458 patients on VAD support between 01/03/20 and 01/03/21, a total of 93 patients received the VAD during that time period, a SARS-CoV-2 infection was confirmed in 30 (6.6%) patients.

Results: Twenty-nine (96.7%) patients were male, the mean age was 65 years, and the mean BMI was 28.7 kg/m². Comorbidities included hypertension (46.7%), diabetes mellitus (33.3%), COPD (23.3%), renal insufficiency (56.7%), heparin-induced thrombocytopenia type II (10%), and a history of stroke (23.3%). Eighteen patients were completely asymptomatic at the time of SARS-CoV-2 confirmation. Nine spent the mandatory quarantine at home, whereas 21 were admitted to hospital or had, in most cases, already been hospitalized.

Dexamethasone administration was necessary in ten patients, 90% of whom were symptomatic at the time of confirmation; however, 50% died nonetheless. With a median follow-up of 83 days in all patients, seven (23.3%) patients died, 6 of who died as a result of severe acute respiratory distress (5) and/or hemorrhagic stroke (3) associated with COVID-19 within less than 3 weeks after the first confirmation of the SARS-CoV-2 infection. Two out of these six patients died despite not showing any symptoms at the time of confirmation. Furthermore, six patients developed acute renal failure, out of which four patients died. In the context of renal failure, two patients developed a hemorrhagic stroke due to accumulation of anticoagulant drugs and resulting derailment in coagulation. However, with all patients in anticoagulation therapy with a target INR of 2.5 to 3, there were no thromboembolic events. Our analysis did not identify any risk factors for a severe manifestation of COVID-19.

Conclusion: VAD patients represent a population with a higher risk for a severe clinical course of COVID-19 compared with the general population and a SARS-CoV-2 infection should raise suspicion regardless of whether the patient has symptoms or not.

Publication History

Article published online:
03 February 2022