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.