key: cord-0904753-f01khqqr
authors: Singh, Rajat; Domenico, Christopher; Rao, Sriram D.; Urgo, Kimberly; Prenner, Stuart B.; Wald, Joyce W.; Atluri, Pavan; Birati, Edo Y.
title: Therapeutic Strategy for Coronavirus Disease 2019 in Patients on Durable Left Ventricular Assist Device Support
date: 2020-05-13
journal: J Card Fail
DOI: 10.1016/j.cardfail.2020.05.001
sha: 08ce7f07e4a0dee33b211899afd0fb4dc688c52f
doc_id: 904753
cord_uid: f01khqqr

nan

We would like to thank Dr. Imamura for his thoughtful letter in response to our recently published report, "Novel Coronavirus Disease 2019 in a Patient on Durable Left Ventricular Assist Device Support." (1) The author raised several important questions regarding the complexity in management of LVAD patients with COVID-19 infection.

Indeed, we agree that patients on durable mechanical support are at high risk and present novel challenges for clinicians if infected with SARS-CoV-2. There are many ongoing issues which need to be further elucidated regarding optimal management in this patient population. As mentioned by Dr. Imamura, veno-venous extra corporeal membrane oxygenation (VV ECMO) should be considered as a rescue strategy in cases of refractory hypoxemia secondary to ARDS. However, due to significant risks and complications associated with VV ECMO, (5) this strategy should be reserved only for the most critically ill patients with refractory hypoxemia despite mechanical ventilation.

As detailed in the paper, our patient did not meet this threshold and was effectively ventilated with conventional management.

In conclusion, management of advanced heart failure patients on durable mechanical circulatory support with COVID-19 infection is challenging given the presence of complex comorbidities and unique physiology of this patient population. To overcome this challenging complexity, we highly recommend managing these patients with a multidisciplinary approach, involving experts from multiple subspecialties including advanced heart failure cardiology, pulmonary critical care, cardiac anesthesia, and infectious disease.

Novel Coronavirus Disease 2019 in a Patient on Durable Left Ventricular Assist Device Support

Prognostic Value of Right Ventricular Longitudinal Strain in Patients with COVID-19

Treatment of ARDS With Prone Positioning

Prone positioning in severe acute respiratory distress syndrome

Systematic review and meta-analysis of complications and mortality of veno-venous extracorporeal membrane oxygenation for refractory acute respiratory distress syndrome