COVID-19 in the Perioperative Period of Cardiovascular Surgery: the Brazilian Experience

Abstract

Introduction We investigated the clinical course and outcomes of patients submitted to cardiovascular surgery in Brazil and who had developed symptoms/signs of coronavirus disease 2019 (COVID-19) in the perioperative period. Methods A retrospective multicenter study including 104 patients who were allocated in three groups according to time of positive real time reverse transcriptase-polymerase chain reaction (RT-PCR) for the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2): group 1, patients who underwent cardiac surgery > 10 days after positive RT-PCR; group 2, patients with a positive RT-PCR within 10 days before or after surgery; group 3, patients who presented positive RT-PCR > 10 days after surgery. The primary outcome was mortality and secondary outcomes were postoperative complications, intensive care unit (ICU) length of stay, and postoperative days of hospitalization. Results The three groups were similar with respect to age, the European System of Cardiac Operative Risk Evaluation score, and comorbidities, except hypertension. Postoperative complications and death were significantly higher in groups 2 and 3 than in group 1, and no significant difference between groups 2 and 3 was seen. Group 2 showed a high prevalence of surgery performed as an urgent procedure. Although no significant differences were observed in ICU length of stay, total postoperative hospitalization time was significantly higher in group 3 than in groups 1 and 2. Conclusion COVID-19 affecting the postoperative period of patients who underwent cardiovascular surgery is associated with a higher rate of morbidity and mortality. Delaying procedures in RT-PCR-positive patients may help reduce risks of perioperative complications and death.

Impact of COVID-19 in the Perioperative Period of Cardiovascular Surgery

“…Such studies corroborate the findings of Gomes et al [ 1 ] that there is high mortality and morbidity associated with COVID-19 infection in patients undergoing cardiovascular surgery Longer hospital stay, pulmonary complications, renal failure and thromboembolic events are present in these patients. Preoperative management protocols and increasingly robust scientific data to understand the evolution of patients between different times of infection are the direction in this time of uncertainty.…”

“…There is great interest from the scientific community in determining the safe period for approaching patients who need cardiovascular surgery in the context of the current pandemic, as well as the complications inherent to COVID-19 infection. The work produced by Gomes et al [ 1 ] , “COVID-19 in the Perioperative Period of Cardiovascular Surgery: the Brazilian Experience”, a multicentric and retrospective analysis of 104 patients, clearly describes the impact of this infection on patients undergoing cardiovascular surgery.…”

Association of major postoperative wound and anastomotic complications in thoracic surgery with COVID-19 infection

“…In the control group, mean hospitalization time was 18 days and none of the patients died. According to Gomes et al, postoperative COVID-19 infection is responsible for prolonged hospitalization and increased mortality compared to patients with the infection detected preoperatively [ 21 ].…”

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

“…Complications such as coagulopathy, secondary bacterial infections, and prolonged weaning, which occurred in these three cases, are common in open heart surgery and may have many causes. Nonetheless, there are few studies in the current scientific literature that demonstrate the association between these complications and previous COVID-19 infection with multisystem involvement [ 15 ]. COVID-19 patients' perioperative mortality (24.5% vs. 24.8%) is comparable to general mortality data (24%) and specialties reporting from multiple surgeries (23.8%) from the COVIDSurg Collaborative [ 16 ].…”