Case 1
A 34-year-old African American man with nonischemic dilated
cardiomyopathy (NDCM), heart failure with reduced ejection fraction
(HFrEF) of <10% (New York Heart Association (NYHA) Class IV,
Stage D) status post implantable cardioverter defibrillator (ICD)
placement, atrial fibrillation, and chronic kidney disease presented in
acute decompensated heart failure and was listed UNOS status 6 for
transplant. For three months after listing, he was managed outpatient
with milrinone. He experienced multiple episodes of ventricular
fibrillation requiring cardioversion, and eventually presented to the
hospital severely hypervolemic, in cardiogenic shock. Venoarterial
extracorporeal membrane oxygenation (ECMO) was placed concomitantly with
an Impella 5.5 (Abiomed, Danvers, MA) device. Persistent right
ventricular dysfunction prevented weaning form mechanical circulatory
support. He was listed UNOS status 1.
Several weeks later, he underwent transplant. Preoperatively, he/donor
tested SARS-CoV-2 negative. He experienced mild asymptomatic acute
cardiac rejection (International Society for Heart and Lung
Transplantation, Grade 1A) on myocardial biopsy, but no other
complications. Standard immunosuppression was implemented after
induction with mycophenolate mofetil. On postoperative day nine, he was
discharged home. On postoperative day sixty, he tested SARS-CoV-2
positive upon routine screening before in-person follow-up but never
exhibited symptoms. He continues to progress well at eight-month
follow-up.