Two-Case Series of Heart Transplant at a Single Center in a SARS-CoV-2 Epicenter
Marlena E. Sabatino, Cassandra Soto, Joshua C. Chao, Alexis Okoh, Hirohisa Ikegami, Anthony Lemaire, Mark J. Russo, Leonard Y. Lee
Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, USA
OBJECTIVE: Recent case series report increased risk of contracting SARS-CoV-2 for African Americans and transplant patients, with a high SARS-CoV-2 fatality rate in heart recipients.
METHODS: This case series identifies all heart transplant patients at a single New Jersey center during the SARS-CoV-2 outbreak through retrospective chart review March 1-May 26, 2020.
RESULTS: We present two patients bridged to transplant with mechanical circulatory support. A 34-year-old black male with atrial fibrillation, chronic kidney disease, familial dilated cardiomyopathy, and HFrEF of 13% managed 6 years with AICD presented acutely decompensated with biventricular failure (NYHA III). He was listed UNOS status 6 and underwent VA-ECMO and Impella 5.5 placement 4- and 3-weeks pre-transplant. After 9 weeks waitlist, he underwent orthotopic heart transplant and was discharged post-operative day (POD) 9. On POD60, he tested SARS-CoV-2 positive but was asymptomatic at that time and at additional 30-day follow-up. The second patient is a 20-year-old black female with diabetes mellitus, asthma, and obstructive sleep apnea with HFrEF of 20% secondary to nonischemic dilated cardiomyopathy. After 13-months management including life vest and AICD, patient was NYHA Class IV Stage D with EF of 5% and Impella 5.5 was implanted. She was listed UNOS status 1 and transplanted 10 weeks later. Patient was discharged POD10 and was doing well at 90-day follow up.
CONCLUSIONS: As SARS-CoV-2 continues to challenge hospital systems, it is necessary to evaluate the safety and efficacy of heart transplantation. With close patient follow-up, this destination therapy may continue successfully despite heightened recipient risk.
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