Horse, Donkey, Or Zebra: Delayed Diagnosis Of Giant Cell Myocarditis
HFSA ePoster Library. Mutschler M. 09/10/21; 343579; 337
Melinda Mutschler
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Abstract
Discussion Forum (0)
Purpose: End-stage heart failure patients are at an increased risk of severe disease and complications from coronavirus disease-2019 (COVID-19). Additionally, the disease increases perioperative risks The purpose of this study was to describe the clinical course following left ventricular assist device (LVAD) implantation in patients with COVID-19.
Methods: A single-center, retrospective review between March 2020 and March 2021 identified 6 patients with a history of COVID-19 who subsequently underwent LVAD implantation. Baseline characteristics, clinical course, and outcomes were examined.
Results: Patients were male (83%), Black (67%), and implanted with a Heartmate 3 for destination therapy. The time from COVID-19 diagnosis to LVAD surgery ranged from 3 days to 6 months (median 40 days, [IQR 12-114 days]). All patients were supported with an intra-aortic balloon pump (IABP) and high-dose inotropes prior to implant. The median age was 60 years (IQR 57-61 years) and body mass index 30 kg/m2 (IQR 24-31 kg/m2). Following implantation, 5 patients (83%) had respiratory failure greater than 7 days on ventilator support, 2 (33%) required tracheostomy, and 2 (33%) were reintubated before successful extubation. Two patients (33%) required temporary right ventricular assist device (RVAD) support, 4 patients (67%) needed continuous renal replacement therapy (CRRT), and 3 patients (50%) suffered ischemic strokes: two patients on postoperative day 1, and the other on postoperative day 5. The median length of hospital stay following surgery ranged from 16 to 73 days (median 53 days, [IQR 35-67 days]). Five patients (83%) were discharged from the hospital, 2 to acute inpatient rehab, 1 to a subacute rehabilitation facility, and 2 to home. Two patients (33%) were readmitted within 30 days for gastrointestinal bleeding and neuropathic pain. There was one (17%) 30-day hospital mortality due to multisystem organ failure following a stroke and the decision to withdraw care.
Methods: A single-center, retrospective review between March 2020 and March 2021 identified 6 patients with a history of COVID-19 who subsequently underwent LVAD implantation. Baseline characteristics, clinical course, and outcomes were examined.
Results: Patients were male (83%), Black (67%), and implanted with a Heartmate 3 for destination therapy. The time from COVID-19 diagnosis to LVAD surgery ranged from 3 days to 6 months (median 40 days, [IQR 12-114 days]). All patients were supported with an intra-aortic balloon pump (IABP) and high-dose inotropes prior to implant. The median age was 60 years (IQR 57-61 years) and body mass index 30 kg/m2 (IQR 24-31 kg/m2). Following implantation, 5 patients (83%) had respiratory failure greater than 7 days on ventilator support, 2 (33%) required tracheostomy, and 2 (33%) were reintubated before successful extubation. Two patients (33%) required temporary right ventricular assist device (RVAD) support, 4 patients (67%) needed continuous renal replacement therapy (CRRT), and 3 patients (50%) suffered ischemic strokes: two patients on postoperative day 1, and the other on postoperative day 5. The median length of hospital stay following surgery ranged from 16 to 73 days (median 53 days, [IQR 35-67 days]). Five patients (83%) were discharged from the hospital, 2 to acute inpatient rehab, 1 to a subacute rehabilitation facility, and 2 to home. Two patients (33%) were readmitted within 30 days for gastrointestinal bleeding and neuropathic pain. There was one (17%) 30-day hospital mortality due to multisystem organ failure following a stroke and the decision to withdraw care.
| Characteristics | PT 1 | PT 2 | PT 3 | PT 4 | PT 5 | PT 6 |
| Age, years | 56 | 64 | 59 | 47 | 61 | 61 |
| Sex | M | M | M | F | M | M |
| BMI | 37 | 32 | 30 | 31 | 19 | 22 |
| Race/Ethnicity | Black | White | Black | Black | Hispanic | Black |
| Hypertension | Y | Y | Y | Y | Y | Y |
| Diabetes | Y | Y | N | Y | N | N |
| Lung Disease | Y | N | Y | N | N | Y |
| Chronic Kidney Disease | N | Y | Y | Y | Y | N |
| Prior Stroke | Y | N | N | N | N | N |
| INTERMACS Profile | 3 | 3 | 3 | 3 | 3 | 3 |
| Time from +SARS-COV-2 PCR to LVAD, days | 7 | 20 | 132 | 18 | 61 | 194 |
| Duration on LVAD support, days | 194 | 33 | 172 | 243 | 45 | 140 |
| Days from implant to discharge | 50 | 30 | 71 | 55 | 16 | 73 |
| Days from implant to extubation | 7 | 30 | 71 | 55 | 16 | 73 |
| Tracheostomy | N | Y | Y | N | N | N |
| RVAD Support | Y | N | N | Y | N | N |
| CRRT | Y | Y | Y | Y | N | N |
| Stroke | N | Y | N | Y | N | Y |
| Alive at end of follow-up | Y | N | Y | Y | Y | Y |
Purpose: End-stage heart failure patients are at an increased risk of severe disease and complications from coronavirus disease-2019 (COVID-19). Additionally, the disease increases perioperative risks The purpose of this study was to describe the clinical course following left ventricular assist device (LVAD) implantation in patients with COVID-19.
Methods: A single-center, retrospective review between March 2020 and March 2021 identified 6 patients with a history of COVID-19 who subsequently underwent LVAD implantation. Baseline characteristics, clinical course, and outcomes were examined.
Results: Patients were male (83%), Black (67%), and implanted with a Heartmate 3 for destination therapy. The time from COVID-19 diagnosis to LVAD surgery ranged from 3 days to 6 months (median 40 days, [IQR 12-114 days]). All patients were supported with an intra-aortic balloon pump (IABP) and high-dose inotropes prior to implant. The median age was 60 years (IQR 57-61 years) and body mass index 30 kg/m2 (IQR 24-31 kg/m2). Following implantation, 5 patients (83%) had respiratory failure greater than 7 days on ventilator support, 2 (33%) required tracheostomy, and 2 (33%) were reintubated before successful extubation. Two patients (33%) required temporary right ventricular assist device (RVAD) support, 4 patients (67%) needed continuous renal replacement therapy (CRRT), and 3 patients (50%) suffered ischemic strokes: two patients on postoperative day 1, and the other on postoperative day 5. The median length of hospital stay following surgery ranged from 16 to 73 days (median 53 days, [IQR 35-67 days]). Five patients (83%) were discharged from the hospital, 2 to acute inpatient rehab, 1 to a subacute rehabilitation facility, and 2 to home. Two patients (33%) were readmitted within 30 days for gastrointestinal bleeding and neuropathic pain. There was one (17%) 30-day hospital mortality due to multisystem organ failure following a stroke and the decision to withdraw care.
Methods: A single-center, retrospective review between March 2020 and March 2021 identified 6 patients with a history of COVID-19 who subsequently underwent LVAD implantation. Baseline characteristics, clinical course, and outcomes were examined.
Results: Patients were male (83%), Black (67%), and implanted with a Heartmate 3 for destination therapy. The time from COVID-19 diagnosis to LVAD surgery ranged from 3 days to 6 months (median 40 days, [IQR 12-114 days]). All patients were supported with an intra-aortic balloon pump (IABP) and high-dose inotropes prior to implant. The median age was 60 years (IQR 57-61 years) and body mass index 30 kg/m2 (IQR 24-31 kg/m2). Following implantation, 5 patients (83%) had respiratory failure greater than 7 days on ventilator support, 2 (33%) required tracheostomy, and 2 (33%) were reintubated before successful extubation. Two patients (33%) required temporary right ventricular assist device (RVAD) support, 4 patients (67%) needed continuous renal replacement therapy (CRRT), and 3 patients (50%) suffered ischemic strokes: two patients on postoperative day 1, and the other on postoperative day 5. The median length of hospital stay following surgery ranged from 16 to 73 days (median 53 days, [IQR 35-67 days]). Five patients (83%) were discharged from the hospital, 2 to acute inpatient rehab, 1 to a subacute rehabilitation facility, and 2 to home. Two patients (33%) were readmitted within 30 days for gastrointestinal bleeding and neuropathic pain. There was one (17%) 30-day hospital mortality due to multisystem organ failure following a stroke and the decision to withdraw care.
| Characteristics | PT 1 | PT 2 | PT 3 | PT 4 | PT 5 | PT 6 |
| Age, years | 56 | 64 | 59 | 47 | 61 | 61 |
| Sex | M | M | M | F | M | M |
| BMI | 37 | 32 | 30 | 31 | 19 | 22 |
| Race/Ethnicity | Black | White | Black | Black | Hispanic | Black |
| Hypertension | Y | Y | Y | Y | Y | Y |
| Diabetes | Y | Y | N | Y | N | N |
| Lung Disease | Y | N | Y | N | N | Y |
| Chronic Kidney Disease | N | Y | Y | Y | Y | N |
| Prior Stroke | Y | N | N | N | N | N |
| INTERMACS Profile | 3 | 3 | 3 | 3 | 3 | 3 |
| Time from +SARS-COV-2 PCR to LVAD, days | 7 | 20 | 132 | 18 | 61 | 194 |
| Duration on LVAD support, days | 194 | 33 | 172 | 243 | 45 | 140 |
| Days from implant to discharge | 50 | 30 | 71 | 55 | 16 | 73 |
| Days from implant to extubation | 7 | 30 | 71 | 55 | 16 | 73 |
| Tracheostomy | N | Y | Y | N | N | N |
| RVAD Support | Y | N | N | Y | N | N |
| CRRT | Y | Y | Y | Y | N | N |
| Stroke | N | Y | N | Y | N | Y |
| Alive at end of follow-up | Y | N | Y | Y | Y | Y |
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