Heart transplantation in the era of COVID-19 pandemic: delirium, post-transplant depression, and visitor restrictions; the role of liaison and inpatient psychosomatic treatment—a case report

Author:

Sadlonova Monika1234ORCID,Gerecke Birgit15ORCID,Herrmann-Lingen Christoph23ORCID,Kutschka Ingo13ORCID

Affiliation:

1. Department of Cardiovascular and Thoracic Surgery, University of Göttingen Medical Center, Robert-Koch-Str. 40, 37075 Göttingen, Germany

2. Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center, Robert-Koch-Str. 40, 37075 Göttingen, Germany

3. German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Germany

4. Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, USA

5. Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany

Abstract

Abstract Background Heart transplant recipients show a high risk of developing major depression with an increased risk of post-transplant morbidity and mortality. Heart transplant specialists and patients face unprecedented challenges during the COVID-19 pandemic, which have enormous clinical implications such as the increased risk of COVID-19 as well as visitor restrictions with social isolation during the post-transplant inpatient treatment. Case summary We present a case of a 64-year-old woman with end-stage heart failure caused by non-compaction cardiomyopathy who received an orthotopic heart transplant (OHT) without any intra-operative complications. Post-operatively, she showed acute psychotic symptoms in the intensive care unit (ICU) with improvement after switching intravenous tacrolimus treatment to an oral intake. Furthermore, the patient developed severe depressive symptoms with malnutrition and had a prolonged hospitalization. Standard medical care was complemented by intensive psychocardiological treatment to overcome the crisis. Conclusion High complexity of the post-transplant management after OHT underlines the importance of multidisciplinary teamwork, involving heart transplant specialists and allied mental health professionals. This collaboration led to an excellent long-term result. Facing the COVID-19 pandemic, the hospital visitor policies may be scrutinized, carefully looking at the role of social isolation, post-operative experience in the ICU, and medical complications after OHT.

Funder

German Heart Foundation through a research scholarship

Göttingen University

Publisher

Oxford University Press (OUP)

Subject

Cardiology and Cardiovascular Medicine

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