Awad Wael I, Bashir Mohamad
Department of Cardiothoracic Surgey, Barts Heart Centre, St Bartholomew's Hospital, London, UK.
Department of Vascular & Endovascular Surgery, Royal Blackburn Teaching Hospital, Blackburn, Lancashire, UK.
J Card Surg. 2021 May;36(5):1723-1728. doi: 10.1111/jocs.15301. Epub 2021 Jan 13.
Coronavirus disease 2019 (COVID-19) is usually mild, but patients can present with pneumonia, acute respiratory distress syndrome (ARDS), and circulatory shock. Although the symptoms of the disease are predominantly respiratory, the involvement of the cardiovascular system is common. Patients with heart failure (HF) are particularly vulnerable when suffering from COVID-19.
To examine the challenges faced by healthcare organizations, and mechanical circulatory support management strategies available to patients with heart failure, during the COVID-19 pandemic.
Extracorporeal membrane oxygenation (ECMO) can be lifesaving in patients with severe forms of ARDS, or refractory cardio-circulatory compromise. The Impella RP can provide right ventricular circulatory support for patients who develop right side ventricular failure or decompensation caused by COVID-19 complications, including pulmonary embolus. HT are reserved for only those patients with a high short-term mortality. LVAD as a bridge to transplant may be a viable strategy to get at-risk patients home quickly. Elective LVAD implantations have been reduced and only patients classified as INTERMACS profile 1 and 2 are being considered for LVAD implantation. Delayed recognition of LVAD-related complications, misdiagnosis of COVID-19, and impaired social and psychological well-being for patients and families may ensue. Remote patient care with virtual or telephone contacts is becoming the norm.
HF incidence, prevalence, and undertreatment will grow as a result of new COVID-19-related heart disease. ECMO should be reserved for highly selected cases of COVID-19 with a reasonable probability of recovery. Special considerations are needed for patients with advanced HF, including those supported by durable LVADs.
2019冠状病毒病（COVID-19）通常症状较轻，但患者可能出现肺炎、急性呼吸窘迫综合征（ARDS）和循环性休克。尽管该疾病的症状主要为呼吸道症状，但心血管系统受累也很常见。心力衰竭（HF）患者感染COVID-19时尤其脆弱。
探讨在COVID-19大流行期间，医疗保健机构面临的挑战以及心力衰竭患者可用的机械循环支持管理策略。
体外膜肺氧合（ECMO）对严重ARDS或难治性心肺循环功能不全患者可挽救生命。Impella RP可为因COVID-19并发症（包括肺栓塞）导致右侧心室衰竭或失代偿的患者提供右心室循环支持。心脏移植仅适用于短期死亡率高的患者。左心室辅助装置（LVAD）作为移植桥梁可能是使高危患者迅速回家的可行策略。择期LVAD植入手术减少，仅考虑为INTERMACS分级1级和2级的患者进行LVAD植入。可能会出现LVAD相关并发症识别延迟、COVID-19误诊以及患者及其家庭的社会和心理健康受损的情况。通过虚拟或电话联系进行远程患者护理正成为常态。
由于新型COVID-19相关心脏病，HF的发病率、患病率和治疗不足情况将会增加。ECMO应仅用于有合理康复可能性的高度选定的COVID-19病例。晚期HF患者，包括那些由耐用LVAD支持的患者，需要特殊考虑。
