COVID-19 in heart transplant patients: Case reports from Brazil.

INTRODUCTION: The COVID-19 pandemic continues, with a late hyperinflammatory phase. The immunosuppressive therapy used in heart transplant patients, in theory, could reduce inflammation, thus benefitting patients with COVID-19. So far, however, there is still very little literature on this subject. METHODS: This is a single-center retrospective study. We described laboratory parameters and clinical outcomes from 11 heart transplant patients with COVID-19 assisted at Dante Pazzanese Institute of Cardiology between March and July 2020. RESULTS: Patients with ages of between 35 and 79 years were enrolled, and heart transplantation ranged from 3 to 264 months. The main comorbidities were diabetes mellitus (9/11; 81.8%), hypertension (10/11; 90.9%), and chronic renal disease (6/11; 54.5%). Cyclosporine A was used in 10 (90.9%) patients, mycophenolate mofetil in 9 (81.8%) patients, and mTOR inhibitor in 5 (45.5%) patients. Fever and cough were observed in 8 (72.7%) patients, and dyspnea and gastrointestinal symptoms in 5 (45.5%) patients. Lymphopenia was observed in 10 (90.9%) patients and thrombocytopenia in 5 (45.5%) patients. The higher level of troponin associated with chest tomography above 50% of bilateral pulmonary infiltrates with ground-glass opacity (GGO) was observed in those with the worst outcomes. Nine patients needed intensive care, and hospital stay ranged from 4 to 21 days, with 2 (18.2%) patients requiring vasopressor drugs and mechanical ventilation, and three (27.3%) patients dying due to COVID-19 complications. CONCLUSION: Heart transplant patients had similar symptoms and outcomes as the general population; immunosuppressive therapy seems not to have protected them. Patients who presented higher levels of troponin and D-dimer, associated with greater GGO pulmonary infiltrates, had worse outcomes. More studies with larger cohorts may clarify immunosuppressive effects on COVID-19 outcomes.

Long Covid as an Indication for Heart Transplantation and Its Characteristics.

BACKGROUND: The post-acute cardiovascular manifestations of COVID-19, known as long COVID, have yet to be comprehensively characterized. There is also an increased risk of heart failure in individuals without cardiovascular disease before SARS-CoV-2 infection. The literature lacks information regarding the characteristics of patients with long COVID who developed advanced heart failure refractory to guideline-directed medical therapy. METHODS: We describe the characteristics of patients with long COVID (LC) who were listed for heart transplantation. The study population comprised 45 patients listed for heart transplantation, divided into 2 groups: patients with etiologies other than LC (n = 41) and patients with LC (n = 4) between January 2020 and March 2022. The endpoint of this study was the description of the characteristics of each group. RESULTS: The average duration of hospitalization after the acute infectious episode with SARS-CoV-2 was 150 ± 113 days, and all patients were hospitalized in New York Heart Association class IV. All LC patients were oligosymptomatic in the initial infection, did not require hospitalization in the acute phase, had a lower ejection fraction, used more intra-aortic balloon pumps, had lower pulmonary vascular resistance, and fewer comorbidities compared with other etiologies, suggesting a clinical feature compatible with low cardiac output rather than congestion. CONCLUSIONS: This study is an early investigation of patients listed for heart transplantation due to a complex syndrome of COVID-19. These preliminary findings warrant further large-scale investigation.