Cardiac surgery outcomes in patients with coronavirus disease 2019 (COVID-19): A case-series report

Abstract

Objective The impact of COVID-19 on the post-operative course of patients after cardiac surgery is unknown. We experienced a major Sars-CoV-2 outbreak in our cardiac surgery unit, with several patients that tested positive early after surgery. Here we describe the characteristics, the post-operative course and laboratory findings of these patients, along with the fate of the health-care workers. We also discuss how we reorganize and reallocate hospital resources in order to resume the surgical activity without further positive patients. Methods After diagnosis of the first symptomatic patient, surgery was suspended. Nasopharyngeal swabs were carried out in all patients and health care workers. Sars-CoV-2 positive patients were isolated and monitored throughout the in-hospital stay and followed-up after discharged until death or clinical recovery. Results Twenty patients were found positive to Sars-CoV-2 sometimes after cardiac surgery (mean age 69±10.4 y/o; median EuroSCORE-II 3(IQR 5.1)); median time from surgery to diagnosis was 15 days (IQR 11). Among them eighteen had received cardiac surgery and two of them transcatheter aortic valve replacement. Overall mortality was 15%. Specific COVID-19 related symptoms were identified in 7 patients (35%). Among the twelve health-care workers infected, one developed a bilateral mild-grade interstitial pneumonia. Conclusion COVID-19 infection after cardiac surgery, regardless the time of the onset, is a serious condition. The systemic inflammatory state that follows the extracorporeal circulation may mask the typical COVID-19 laboratory findings, making the diagnosis more problematic. A capillary reorganization of the hospital resources is necessary in order to safely resume the cardiac surgical activity.

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