COVID-19 in orthotopic heart transplant recipients and association with donor specific antibodies.

De novo donor-specific antibodies (DSAs) are associated with increased risk of antibody-mediated rejection and worse clinical outcomes after orthotopic heart transplant (OHT). No study has reported the production of DSAs after infection by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in an OHT population. In this retrospective study, we described coronavirus disease 2019 (COVID-19) incidence and clinical course in a large, contemporary OHT cohort. We showed that the case-fatality rate has significantly decreased since the early days of the pandemic, although remains higher than that of the general population. In addition, we found that 10% of OHT recipients developed de novo DSAs or experienced an increase in pre-existing DSAs after COVID-19, with the majority occurring in unvaccinated patients (15% vs 2%). Further studies are necessary to substantiate our findings in an external cohort.

Perclose Closure Device breakage and embolization during deployment followed by retrieval with snare.

Perclose Closure Device (Abbott-Vascular) was attempted for femoral artery (FA) access site closure by an experienced operator. The device was felt to snap as it was pushed through the previously scarred skin and subcutaneous tissue. Perclose had broken into two pieces with the proximal portion outside the body and the distal portion embolizing to lie in the FA to distal aorta. The left FA was accessed through 8F sheath and 4-8mm Basket snare passed through a 6F multipurpose guiding catheter. The tip of the broken Perclose was caught with the snare and pulled out. The Perclose has a distal flexible sheath that is overmolded directly onto the proximal rigid guide. This junction of sheath and guide may be a weak point. Accidental pressure applied at this weak point in any Perclose device during deployment can cause breakage. Awareness of this rare complication is important for safety.