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Emergency biventricular assist device implantation in a patient with suspected COVID-19 disease.

ABSTRACT: Severe coronavirus disease 2019 (COVID-19) is a multisystem inflammatory disorder and knowledge and experience with severe acute respiratory failure in infected patients has grown considerably since reports of the first few cases. Little is known about the effect of the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) virus on the heart, and it has been suggested that fulminant cardiac failure, with or without respiratory failure, may occur several weeks following infection. A young man presented after a recent viral illness. He was in severe cardiogenic shock and was implanted with an emergency biventricular assist device, which also incorporated an extracorporeal membrane oxygenator. He stabilised soon after and, despite an intracerebral haemorrhage which resolved and bleeding into the trachea following percutaneous tracheostomy, he survived to explant and was successfully stepped down to a rehabilitation unit on postoperative day 50. He tested positive for SARS-CoV-2 antibodies when the test became available on postoperative day 33. We envisage there will be many more such presentations of acute COVID-19-associated cardiogenic shock and we recommend clinicians consider this diagnosis when presented with an acutely unwell patient with an unclear diagnosis following a viral illness. These patients should be discussed as early as possible with a transplant/mechanical circulatory support team.

SUBMITTER: Nwaejike N

PROVIDER: S-EPMC7772647 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Computational models have become essential in predicting medical device efficacy prior to clinical studies. To investigate the performance of a left-ventricular assist device (LVAD), a fully-coupled cardiac fluid-electromechanics finite element model was developed, incorporating electrical activation, passive and active myocardial mechanics, as well as blood hemodynamics solved simultaneously in an idealized biventricular geometry. Electrical activation was initiated using a simplified Purkinje network with one-way coupling to the surrounding myocardium. Phenomenological action potential and excitation-contraction equations were adapted to trigger myocardial contraction. Action potential propagation was formulated within a material frame to emulate gap junction-controlled propagation, such that the activation sequence was independent of myocardial deformation. Passive cardiac mechanics were governed by a transverse isotropic hyperelastic constitutive formulation. Blood velocity and pressure were determined by the incompressible Navier-Stokes formulations with a closed-loop Windkessel circuit governing the circulatory load. To investigate heart-LVAD interaction, we reduced the left ventricular (LV) contraction stress to mimic a failing heart, and inserted a LVAD cannula at the LV apex with continuous flow governing the outflow rate. A proportional controller was implemented to determine the pump motor voltage whilst maintaining pump motor speed. Following LVAD insertion, the model revealed a change in the LV pressure-volume loop shape from rectangular to triangular. At higher pump speeds, aortic ejection ceased and the LV decompressed to smaller end diastolic volumes. After multiple cycles, the LV cavity gradually collapsed along with a drop in pump motor current. The model was therefore able to predict ventricular collapse, indicating its utility for future development of control algorithms and pre-clinical testing of LVADs to avoid LV collapse in recipients.

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Emergency biventricular assist device implantation in a patient with suspected COVID-19 disease.

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