Background Both coronavirus disease (COVID‐19) and cardiac surgery have a negative impact on pulmonary function. This study aimed to determine the postoperative respiratory outcomes of patients with COVID‐19 who underwent cardiac surgery. Methods In this retrospective study, we reviewed and analyzed the patient characteristics and clinical data of 25 asymptomatic patients with COVID‐19 who underwent urgent or emergency cardiac surgery at Tehran Heart Center Hospital, Iran, between 29 February and 10 April 2020. Results The mean age, EuroSCORE, and body mass index were 57.3 ± 15.1 years, 6.65 ± 1.29, and 25.7 ± 3.7 kg/m2, respectively. Four patients underwent off‐pump cardiac surgery and 21 underwent on‐pump cardiac surgery with a median cardiopulmonary bypass time of 85 minutes (interquartile range (IQR, 50‐147). The overall mortality rate and the length of stay in the intensive care unit (ICU) were higher compared to those of a propensity‐matched group of patients who underwent cardiac surgery in the pre‐COVID era. The median intubation time was 13 hours (IQR, 9.5‐18), which was comparable to that of pre‐COVID cardiac surgery patients. The readmission rate to the ICU was 16%. In this ICU readmitted group, the mean oxygen index, FiO2, and mortality rate were higher and the PaO2/FiO2 ratio was lower than those of the nonreadmitted patients. Conclusions Although early respiratory outcomes of asymptomatic COVID‐19 patients who underwent early cardiac surgery appeared to be satisfactory, compared to the propensity‐scored matched non‐COVID group, the postoperative outcomes were worse, especially in the ICU readmitted patients. We suggest postponing cardiac operations unless the patient requires emergency surgery.

We determined the association of vitamin D deficiency and the FokI polymorphism of the vitamin D receptor (VDR) gene in 760 patients who underwent angiography due to suspected coronary artery disease (CAD). Angiography and the Rentrop scoring system were used to classify the severity of CAD in each patient and to grade the extent of collateral development, respectively. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was used to determine the FokI VDR gene polymorphism. The prevalence of severe vitamin D deficiency (serum 25(OH)D < 10 ng/mL) was significantly higher in patients with at least one stenotic coronary artery compared to those without any stenotic coronary arteries. Severe vitamin D deficiency was not independently associated with collateralization, but it was significantly associated with the VDR genotypes. In turn, VDR genotype was independently associated with the degree of collateralization; the Rentrop scores were the highest in FF, intermediate in Ff, and the lowest in the ff genotype. The results show that FokI polymorphism is independently associated with collateralization. Additionally, vitamin D deficiency is more prevalent in patients with CAD that may result from FokI polymorphism. Therefore, maintaining a normal vitamin D status should be a high priority for patients with CAD.

The objective of this study was to describe early respiratory outcomes of asymptomatic COVID-19 patients after cardiac surgery. In this retrospective clinical study (case series) we reviewed and analyzed patient clinical data of 25 covid-19 asymptomatic patients that underwent urgent or emergent cardiac surgery between February 29 and April 10, 2020 in Tehran Heart Center Hospital. Median of age was 63 years (IQR, 52-67), Euro SCORE 7.50 (IQR, 6.5-8.5) and body mass index 26.3 (IQR, 22.5-28.6). 68% of patients had one or more comorbidities. Hypertension (56%) was the most common followed by Diabetes type 2 (40%). Off-pump cardiac surgery was done in 4 patients and on-pump on 21 patients with median CPB time of 85 minutes (IQR, 50-147.50). Median anesthesia time was 4.5 hours (IQR, 4-5). Median oxygen index and Fio2 on ventilator were 10 cmH20 (IQR, 9.5-10.5) and 0.64(IQR, 0.60-0.64) respectively. Median pao2/Fio2 was 231(IQR, 184-261). There was one case of extubation failure. The Median intubation time and length of ICU stay were 13 hours (IQR, 9.5-18) and 3 days (IQR, 2-4) respectively. Overall mortality was 16%. Readmission rate to ICU was 16% with. In this group respiratory outcome was worse with median Pao2/Fio2 84.5 (75-122), oxygen index of 4.38(IQR, 3.77-5.1) and morality rate of 75%. Conclusion: Based on the results of this study, very early post-cardiac surgery respiratory outcomes in asymptomatic COVID-19 patients are apparently smooth; nonetheless, readmission to the ICU is high. Overall respiratory outcomes are poor especially for those who readmitted to ICU.

Predictors and Early Outcome of ProlongedResults: PMV occurred in 6.6% of patients. Initial ventilation hours, atrial fibrillation, cardiac arrest and reintubation were the most prevalent postoperative complications. Preoperative renal failure, postoperative stroke, intra aortic balloon pump insertion, emergent operation, complete heart block, longer perfusion time were independent predictors of PMV in our patients.Conclusion: PMV is associated with significant comorbidities and increased hospital mortality. Strategies to delineate the patients at risk and to modify these risk factors by prophylactic measures should probably lead to a lower incidence of prolonged mechanical ventilation for patients undergoing isolated valve surgery.

The effects of recent Covid-19 pandemic on this planet must be viewed with a wise eye and we should learn that human beings are interconnected chains, and that ignoring the laws of existence will undoubtedly continue with reflections similar to the way we are today. Although the community of heart surgeons is not at the forefront of the treatment of this epidemic, they are ready to rush to the aid of other colleagues if necessary. The aim of preparing this protocol is to prioritize cardiac surgery procedures, maintain blood and blood product reserves and provide the appropriate care for patients while taking precautions for the safety of medical staff. The general recommendation in this first version of protocol is to postpone all elective cardiac surgeries and perform emergent and urgent cases according to suggested personal protection strategies for Covid-19.

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AbstractAnemia is an indisputable finding in patients scheduled for coronary artery bypass graft (CABG) that can occur any time preoperatively. In presence of severe coronary artery disease, anemia can dramatically affect surgical outcomes. Therefore, we conducted this study to determine the effect of low preoperative hemoglobin (Hgb) on postoperative outcome in patients who underwent coronary artery bypass graft (CABG). In all, 4432 patients who had undergone isolated CABG at Tehran Heart Center over the 2-year period from March 2006 to February 2008 were studied. All medical records of the aforementioned patients were derived from our hospital surgery data bank. After adjustment for confounders, the association of different preoperative levels of Hgb with risk of cardiac, pulmonary, infectious, and ischemic complications, and also with prolonged ventilation and resource utilization, were assessed in a multivariable model. After adjustment for confounders that may affect mortality and morbidities, we found that cardiac, infectious, ischemic, and pulmonary complications, as well as postoperative mortality, were significantly higher in anemic patients compared to those with normal Hgb levels. In addition, total ventilation time, total intensive care unit hour stay (ICU), hospital length of stay (HLOS), and postsurgery length of stay (PLOS) were significantly longer in anemic patients. We concluded that isolated CABG patients with preoperative anemia have significantly higher mortality and morbidity, and use more health care resources. Preoperative anemia is an independent variable for increased resource utilization, morbidity, and mortality.

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