PT Unknown AU Rassaf, T Totzeck, M Mahabadi, AA Hendgen-Cotta, U Korste, S Settelmeier, S Luedike, P Dittmer, U Herbstreit, F Brenner, T Klingel, K Hasenberg, M Walkenfort, B Gunzer, M Schlosser, T Weymann, A Kamler, M Schmack, B Ruhparwar, A TI Ventricular assist device for a coronavirus disease 2019-affected heart PD 11 PY 2020 DI 10.1002/ehf2.13120 LA en DE COVID-19; SARS-CoV-2; Light sheet microscopy; Electron microscopy AB Coronavirus disease 2019 (COVID-19) is challenging the care for cardiovascular patients, resulting in serious consequences with increasing mortality in pre-diseased heart failure patients. In the current state of the pandemic, the physiopathology of COVID-19 affecting pre-diseased hearts and the management of terminal heart failure in COVID-19 patients remain unclear. We outline the findings of a young COVID-19 patient suffering from idiopathic cardiomyopathy who was treated for acute multi-organ failure and required cardiac surgery with implantation of a temporary right ventricular and durable left ventricular assist device (LVAD). For deeper translational insights, we used in-depth tissue analysis by electron and light sheet fluorescence microscopy revealing evidence for spatial distribution of severe acute respiratory syndrome coronavirus 2 in the heart. This indicates that in-depth analysis may represent a valuable tool in understanding indistinct clinical cases. We conclude that COVID-19 directly affects pre-diseased hearts, but the consequences can be treated successfully with LVAD implantation. ER