Cardiac surgery on patients with COVID‐19: a systematic review and meta‐analysis

Abstract

Introduction:The COVID-19 pandemic has had a significant impact on global surgery. In particular, deleterious effects of SARS-CoV-2 infection on the heart and cardiovascular system have been described. To inform surgical patients, we performed a systematic review and meta-analysis aiming to characterize outcomes of COVID-19 positive patients undergoing cardiac surgery. Methods: The study protocol was registered with PROSPERO (CRD42021228533) and conformed with PRISMA 2020 and MOOSE guidelines. PubMed, Ovid MEDLINE and Web of Science were searched between 1 January 2019 to 24 February 2022 for studies reporting outcomes on COVID-19 positive patients undergoing cardiac surgery. Study screening, data extraction and risk of bias assessment were conducted in duplicate. Meta-analysis was conducted using a random-effects model where at least two studies had sufficient data for that variable. Results: Searches identified 4223 articles of which 18 studies were included with a total 44 patients undergoing cardiac surgery. Within these studies, 12 (66.7%) reported populations undergoing coronary artery bypass graft (CABG) surgery, three (16.7%) aortic valve replacements (AVR) and three (16.7%) aortic dissection repairs. Overall mean postoperative length of ICU stay was 3.39 (95% confidence interval (CI): 0.38, 6.39) and mean postoperative length of hospital stay was 17.88 (95% CI: 14.57, 21.19). Conclusion: This systematic review and meta-analysis investigated studies of limited quality which characterized cardiac surgery in COVID-19 positive patients and demonstrates that these patients have poor outcomes. Further issues to be explored are effects of COVID-19 on decisionmaking in cardiac surgery, and effects of COVID-19 on the cardiovascular system at a cellular level.

Impact of the COVID-19 Pandemic on the Use and Outcomes of Cardiac Procedures in COPD Patients

“…Inconclusive results have been reported by other studies that have observed either increases or no changes in IHM in relation to such interventions before and during the COVID-19 pandemic [27][28][29][30][31]. In a recent systematic review and meta-analysis, it was reported that COVID-19 patients undergoing cardiac surgery have poor outcomes [32]. These results were confirmed in our investigation where IHM was much higher among patients with COVID-19 infection (Tables S3 and S4).…”

“…Various studies have indicated that SARS-CoV-2 infection acts on endothelial cells not only in the lungs but also in blood vessels and the heart, causing deterioration processes, such as inflammation and oxidative stress, and numerous cardiovascular complications. In addition, new data shows that even asymptomatic patients, not just patients with symptoms, can experience these complications immediately after illness, in the next 30 days, and even after a year [32,33].…”

Paradigm shift: Beyond the COVID‐19 era, is YouTube the future of education for CABG patients?

“…36 For surgical systems worldwide, preoperative screening, triage, and intraoperative practice has been affected by the risk of COVID-19 transmission in the community. [37][38][39][40] Modern technology allows healthcare to be delivered and consumed through the internet, whilst also limiting physical movement of persons and in effect, lowering the density per area of people at healthcare centers. The combined effect has been to reduce risks of COVID-19 transmission to patients and healthcare staff.…”

“…This has resulted in less face‐to‐face medical care and provides a challenge in delivering healthcare 36 . For surgical systems worldwide, preoperative screening, triage, and intraoperative practice has been affected by the risk of COVID‐19 transmission in the community 37–40 . Modern technology allows healthcare to be delivered and consumed through the internet, whilst also limiting physical movement of persons and in effect, lowering the density per area of people at healthcare centers.…”

A Case Series of Problems That Can Occur During Open Heart Surgery in Patients With COVID-19 Infection

“…Open heart surgery in patients with coronavirus disease 2019 (COVID-19) infection creates various problems, such as coagulopathy, hypoxia, difficulty weaning, and susceptibility to secondary bacterial infections. In addition to surgical trauma, impaired extracorporeal circulation and impaired myocardial and pulmonary reserve can lead to immunosuppression and coagulopathy, which further complicate the management of these patients [ 1 , 2 ].…”