Early Respiratory Outcomes Following Cardiac Surgery in Patients with COVID-19

Abstract

The objective of this study was to describe early respiratory outcomes of asymptomatic COVID-19 patients after cardiac surgery. In this retrospective clinical study (case series) we reviewed and analyzed patient clinical data of 25 covid-19 asymptomatic patients that underwent urgent or emergent cardiac surgery between February 29 and April 10, 2020 in Tehran Heart Center Hospital. Median of age was 63 years (IQR, 52-67), Euro SCORE 7.50 (IQR, 6.5-8.5) and body mass index 26.3 (IQR, 22.5-28.6). 68% of patients had one or more comorbidities. Hypertension (56%) was the most common followed by Diabetes type 2 (40%). Off-pump cardiac surgery was done in 4 patients and on-pump on 21 patients with median CPB time of 85 minutes (IQR, 50-147.50). Median anesthesia time was 4.5 hours (IQR, 4-5). Median oxygen index and Fio2 on ventilator were 10 cmH20 (IQR, 9.5-10.5) and 0.64(IQR, 0.60-0.64) respectively. Median pao2/Fio2 was 231(IQR, 184-261). There was one case of extubation failure. The Median intubation time and length of ICU stay were 13 hours (IQR, 9.5-18) and 3 days (IQR, 2-4) respectively. Overall mortality was 16%. Readmission rate to ICU was 16% with. In this group respiratory outcome was worse with median Pao2/Fio2 84.5 (75-122), oxygen index of 4.38(IQR, 3.77-5.1) and morality rate of 75%. Conclusion: Based on the results of this study, very early post-cardiac surgery respiratory outcomes in asymptomatic COVID-19 patients are apparently smooth; nonetheless, readmission to the ICU is high. Overall respiratory outcomes are poor especially for those who readmitted to ICU.

Stuck Between a Rock and a Hard Place: The Clinical Conundrum of Managing Cardiac Surgical Patients During the SARS-CoV-2 Pandemic

“…The results presented by Bonalumi and colleagues are similar to those reported in other surgical services amongst COVID-19 patients in Italy 6 , as well as analyses of cardiac surgical patients with COVID-19 at other centres. [7][8][9] The summation of the available evidence points towards the serious consideration clinicians must give to deferring non-emergent cardiac surgery of COVID-19 patients, particularly amongst those with advanced age or sub-optimal pulmonary function.…”

The Outcomes of Patients Incidentally Confirmed with Covid-19 After Cardiac Surgery

“…Unfortunately, classifying cardiac surgery patients is a double-edged sword since they have some comorbid diseases, such as diabetes and hypertension, that increase the risk of Covid-19. Mortality and morbidity rates in patients confirmed with Covid-19 who had ST-segment elevation [Bangalore 2020;Giulio 2020] or cardiac surgery [ Barkhordari 2020] have been reported in a limited number of reports. Barkhordari et al reported that outcomes of urgent cardiac surgery in patients confirmed with Covid-19 were poor, and serious respiratory complications rates were high when compared with similar patients in the pre-pandemic period (2% vs. 16%) [ Barkhordari 2020].…”

Commentary: Preoperative Screening CT: Not Ready for Primetime in The COVID-19 Era

“…The coronavirus disease 2019 (COVID-19) pandemic is not only associated with marked global morbidity and mortality, but also poor outcomes after cardiac surgery. 1 In this setting, an effective preoperative screening tool is necessary to optimize cardiac surgical outcomes, especially among asymptomatic patients who may be SARS-CoV-2 positive by reverse transcriptase polymerase chain reaction (RT-PCR).…”