Heart Transplantation Single Center Experience of 63 Heart Transplantation Procedures Performed during the COVID 19 Pandemic

Purpose The COVID19 (C19) pandemic has resulted in a significant reduction in cardiac surgical procedures worldwide and in particular heart (OHT) transplantations. This was primarly due to increased risk of C19 infection and severity in immunocompromised patients (pts). Donor aviability decreased steeply, as intensive care units are struggling with C19 patients. Yet, number of patients requiring OHT increased rapidly, comprising of individuals with dreadful complications of untreated acute coronary syndromes. Methods Between March and October 2020 63 pts underwent OHT. The age range was 21-65 yrs and a median of 52 yr. All patients were evaluated by a multidisciplinary heart failure team (MDT), and placed on the HT waiting list once eligible. Once a donor has been identified, clinical history and examination obtained, a chest CT was taken and real time RTPCR test is ordered. Every recipient was subject to clinical screening, chest XRay, real RTPCR (24 hrs within HT)upon admission. All pts were looked after by experienced staff who tested negative for SARS-CoV-2, wearing PPE, working in isolation, single room care and visitors were not admitted. Results No recipient or donor tested positive for SARS-CoV-2 at any stage in their care. 5 (8%) pts died, >30 days after the procedure, of multiorgan failure; all 5 pts were in INTERMACS II at the time of OHT. All patients were managed with our standard immunosuppression therapy consisting of mycofenolante mofetil and steroids in addition to calcineurin inhibitor (tacrolimus). According to recent results 25 patients (40%) had allograft rejection of ISHLT grade 3a detected by routine endomyocardial biopsies within first 3 months. The highdose steroids therapy was involved and positive response (ISHLT grade 0) was observed. 56 pts had a hospital stay of 30 d or less, 7 pts more than 30 d. Follow up visits were conducted using telemedicine unless it was absolutely necessary to see the pt in hospital. Also, we raised the threshold for endomyocardial biopsies by relying on clinical judgement and stable allograft function. Conclusion By creating a robust system of care based on team work, early testing and retesting of patients and staff for SARSCoV2, the use of proper PPE's, adequate isolation and subsequent minimization of contact with pts, we were able to demonstrate that HT in the era of COVID19 pandemic can be performed safely.