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The coronavirus disease 2019 (COVID-19) may lead to an acute respiratory distress syndrome by an inappropriate cytokine response and may predispose to a prothrombotic state through multiple pathways. Both can complicate the management of cardiac surgery with cardiopulmonary bypass, which is known to activate the hemostatic system and to exacerbate systemic inflammatory response. Little is known about the impact of cardiac surgery with cardiopulmonary bypass on viral pneumonia, particularly with the new coronavirus. In this article, we describe the case of a diabetic patient with COVID-19 and a concomitant 3-vessel disease with a formal indication for surgical revascularization, who unexpectedly presented with a high heparin resistance during cardiopulmonary bypass. Emphasis is placed on the importance of multidisciplinary team discussions before surgery, on the thorough preoperative assessment, and on the perioperative management, particularly regarding mechanical ventilation and anticoagulation.

We report the perioperative management of a patient with pulmonary hypertension under new-generation treatments who underwent laparoscopic surgery. Preoperatively, arterial catheter, central venous line, and transesophageal echocardiography probe were inserted in addition to standard monitoring. Intraoperatively, inhaled nitric oxide was used because of increasing pressure in the right heart chambers related to the Trendelenburg position and the pneumoperitoneum. The operation finally lasted <2 hours without complication. The prognosis of patients with pulmonary hypertension has evolved since the advent of new management strategies. Thorough preoperative assessment and multidisciplinary discussion in a referral center are essential for medical optimization.

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