Outcomes of COVID-19 Infection in Patients with Left Ventricular Assist Device

Purpose

Left ventricular assist device (LVAD) patients are presumed to be high risk for novel SARS-CoV2 virus complications given their multiple comorbidities. Data on COVID-19 outcomes in LVAD patients is limited. Our single-center, retrospective, cohort study aimed to study the characteristics and outcomes of LVAD patients with COVID-19 infection.

Methods

Institutional IRB approval was obtained. A total of 70 Heartmate 3 (HM3) LVAD patients at our center were screened from December 2019 - September 2021. Variables analyzed included mortality, need for hospitalization, respiratory failure, thromboembolic events, bleeding events, and International Normalized Ratio (INR).

Results

The rate of COVID-19 infection in our cohort of 70 patients was 15.7% (n=11) similar to the rate observed in the state of Texas (14.1%). The average time interval between LVAD implantation and COVID-19 infection was 41.1 months. 63% (n=7) patients when to ER/hospitalized with a mortality rate of 9% (n=1). All patients had community-acquired infections except one patient who acquired from a visiting family member at the hospital. 81% (n=9) patients acquired the infection during a period of high-infectivity rate in the state of Texas (November 2020-February 2021). Cough was the most common symptom (63.3%, n=7). No patient required intubation. One patient with DNR status who was also unvaccinated died of acute respiratory failure. Three patients developed chronic hypoxic respiratory failure. There were no incidents of pump thrombosis, strokes, or pulmonary embolisms. 72% of patients had an INR >2.0 closest to testing COVID+ with an average INR of 3.5 (range: 1.3 - 9.7). As of September 2021, 63% are vaccinated.

Conclusion

COVID-19 infection in LVAD patients can result in substantial morbidity requiring hospitalization and/or death. Interestingly, in our series, no patients suffered a thromboembolic event. Thus, the superior hemocompatibility of the Heartmate 3 device seems resistant to the reputed hypercoagulability of COVID infection.