Clinical Course of COVID-19 Infection in Patients Urgently Operated of Cardiac Surgical Procedures

Abstract

Objective: The aim of this study was to describe the clinical course of a consecutive series of patients operated of urgent cardiac surgery during COVID-19 outbreak. Background: In Italy, COVID outbreak has mostly occurred in the metropolitan area of Milan, and in the surrounding region of Lombardy, and previously “conventional” hospitals were converted into COVID spokes to increase ICU beds availability, and to allow only urgent CS procedures. Methods: Among urgent CS patients (left main stenosis with unstable angina, acute endocarditis, valvular regurgitation with impending heart failure), 10 patients (mean age = 57 ± 9 years), despite a negative admission triage, developed COVID-pneumonia postoperatively, at a median of 7 days after CS. Results: Patients showed typical lymphopenia, higher prothrombotic profile, and higher markers of inflammation (ferritin and interleukin-6 values). At the zenith of pulmonary distress, patients presented with severe hypoxia (median PaO2/FIO2 ratio = 116), requiring advanced noninvasive ventilation (Venturi mask and continuous positive airway pressure) in the majority of cases. All patients were treated with hydroxychloroquine, azithromycin, and low-molecular-weight heparin at anticoagulant dose. Overall in-hospital mortality was 10% (1/10), peaking 25% in patients who developed COVID pneumonia immediately after CS. The remaining patients, with late infection, were all discharged home without oxygen support, at a median of 25 days after symptom onset. Conclusions: As postoperative mortality in case of COVID pneumonia is not negligible, meticulous rules (precise triage, safe hospital path, high level of protection for health-care teams, prompt diagnosis of suspicious symptoms) should be strictly followed in patients undergoing CS during COVID pandemic. The role of therapies alternative to CS should be further assessed.

A Systematic Review and Meta-Analysis of Inpatient Mortality Associated With Nosocomial and Community COVID-19 Exposes the Vulnerability of Immunosuppressed Adults

“…A fixed interval between admission and diagnosis was employed in 14/21 (62%) ranging from >2 days (37) >14 days (12), supplemented by additional patient-level clinical data (40) and viral whole genome sequencing (38). Seven studies primarily employed epidemiological nosocomial definitions, for instance a history of close contact with positive cases [n=3 (27,31,39)], or the absence of symptoms on admission with subsequent positive test [n=2 (10,30)]. Two studies gave no explicit nosocomial case definition (24,28).…”

COVID-19 as a systemic disease

“…Важно подчеркнуть, что не только это, но и несколько других исследований показывают возможность выявления признаков кардита и присутствия вирусной РНК в миокарде после кажущегося выздоровления от COVID-19 [96,97], если это заболевание было легким, протекало латентно и не было подтверждено ПЦР-анализом мазков из слизистой оболочки носоглотки [97,100] Что касается эндокардита, то имеются лишь единичные описания бактериальных форм этой патологии, сопутствующей или осложняющей COVID-19 [101][102][103]. Причем отмечается запоздалое распознавание, трудности дифференциальной диагностики и заметное снижение выявляемости бактериального эндокардита в реальных условиях пандемии [104][105]. Эндокардитлифоцитарный и тромботический (марантический)несмотря на редкость прижизненного выявления [90,106] скорее можно считать закономерным и частым осложнением, они отмечены в 11% вскрытий [107].…”

A systematic review and meta-analysis of inpatient mortality associated with nosocomial and community COVID-19 exposes the vulnerability of immunosuppressed adults

“…A further 48 studies were excluded as they did not report mortality within both community and nosocomial-acquired COVID-19 patient groups. This left 21 studies for primary meta-analysis (9)(10)(11)(12)(13)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46), summarised in…”

“…A fixed interval between admission and diagnosis was employed in 14/21 (62%) ranging from >2 days (45) to >14 days (12), supplemented by additional patient-level clinical data (41) and viral whole genome sequencing (32). Seven studies primarily employed epidemiological nosocomial definitions, for instance a history of close contact with positive cases (n=3, (31,39,43)), or the absence of symptoms on admission with subsequent positive test (n=2, (10,35)). Two studies gave no explicit nosocomial case definition (33,36).…”