Effects of cardiopulmonary bypass on immunoglobulin G antibody titres after SARS-CoV2 vaccination

Hayashi, Rumiko; Takami, Yoshiyuki; Fujigaki, Hidetsugu; Amano, Kazuyuki; Sakurai, Yasuhisa; Akita, Kiyotoshi; Yamana, Koji; Maekawa, Atsuo; Takagi, Yasushi

doi:10.1093/icvts/ivac123

Cited by 4 publications

(2 citation statements)

References 19 publications

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“…Hayashi and colleagues reported the results of their prospective study of Japanese patients undergoing surgery from July through November 2021. 18 A total of 63 patients were enrolled in the study: 24 underwent cardiovascular procedures not requiring CPB and 39 required CPB. All patients had received a complete COVID‐19 vaccination series.…”

Section: Discussionmentioning

confidence: 99%

Effect of Cardiopulmonary Bypass on SARS‐CoV‐2 Vaccination Antibody Levels

Strobel,

Narahari,

Rotar

et al. 2023

JAHA

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Background Adults undergoing heart surgery are particularly vulnerable to respiratory complications, including COVID‐19. Immunization can significantly reduce this risk; however, the effect of cardiopulmonary bypass (CPB) on immunization status is unknown. We sought to evaluate the effect of CPB on COVID‐19 vaccination antibody concentration after cardiac surgery. Methods and Results This prospective observational clinical trial evaluated adult participants undergoing cardiac surgery requiring CPB at a single institution. All participants received a full primary COVID‐19 vaccination series before CPB. SARS‐CoV‐2 spike protein‐specific antibody concentrations were measured before CPB (pre‐CPB measurement), 24 hours following CPB (postoperative day 1 measurement), and approximately 1 month following their procedure. Relationships between demographic or surgical variables and change in antibody concentration were assessed via linear regression. A total of 77 participants were enrolled in the study and underwent surgery. Among all participants, mean antibody concentration was significantly decreased on postoperative day 1, relative to pre‐CPB levels (−2091 AU/mL, P <0.001). Antibody concentration increased between postoperative day 1and 1 month post CPB measurement (2465 AU/mL, P =0.015). Importantly, no significant difference was observed between pre‐CPB and 1 month post CPB concentrations ( P =0.983). Two participants (2.63%) developed symptomatic COVID‐19 pneumonia postoperatively; 1 case of postoperative COVID‐19 pneumonia resulted in mortality (1.3%). Conclusions COVID‐19 vaccine antibody concentrations were significantly reduced in the short‐term following CPB but returned to pre‐CPB levels within 1 month. One case of postoperative COVID 19 pneumonia‐specific mortality was observed. These findings suggest the need for heightened precautions in the perioperative period for cardiac surgery patients.

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Section: Discussionmentioning

confidence: 99%

Effect of Cardiopulmonary Bypass on SARS‐CoV‐2 Vaccination Antibody Levels

Strobel,

Narahari,

Rotar

et al. 2023

JAHA

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“…We previously reported a significant reduction of antibodies acquired by SARS-CoV-2 vaccination immediately after the surgery under CPB. 12 . We also reported a positive correlation between the antibody preserved rates at a month after the surgery and the interval from vaccination to surgery.…”

Section: Introductionmentioning

confidence: 99%

Optimal timing of SARS-CoV-2 vaccination prior to cardiovascular surgery under cardiopulmonary bypass

Hayashi,

Takami,

Fujigaki

et al. 2024

Int J Artif Organs

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Background: mRNA vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) became common. We investigated the optimal timing for inoculation against SARS-COV-2 in the candidates for cardiac surgery under cardiopulmonary bypass (CPB). Methods: In 100 patients with preoperative vaccination, who underwent CPB surgery between July 2021 and February 2022, the IgG against the receptor binding domain (RBD-IgG), with a threshold of >100 binding antibody unit (BAU)/mL for adequate immunity, was measured. Results: The vaccines, including 87 BNT162b2 (Pfizer/BioNTech) and 13 mRNA-1273 (Moderna), were inoculated at 98.8 ± 59.4 days before surgery. The median RBD-IgG titers before surgery, 1 day after surgery, and 1 month after surgery were 166.8, 100.0, and 84.0 BAU/mL, respectively. The standby interval (SBI) from the vaccination to the surgery showed a significantly negative correlations with the RBD-IgG titer before the surgery ( p < 0.001). A cut-off SBI for RBD-IgG >100 BAU/mL before surgery was <81 days with a sensitivity of 76%, specificity of 62%, and area under ROC value of 0.73 ( p = 0.03). The patients with SBI <81 days ( n = 48) had significantly higher RBD-IgG (>100 BAU/mL) than those with SBI ⩾81 days ( n = 52) at all perioperative periods. Conclusions: Although 40% of the RBD-IgG titers reduce 1 day after CPB surgery, the patients who received the SARS-COV-2 vaccination within an 81-day window prior to the surgery maintained a desirable RBD-IgG level, even up to 1 month after surgery. It may be important to schedule the surgery no later than 81 days after the vaccination.

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Immunisation deferral practices surrounding congenital heart surgery

Gal,

Cleveland,

Vergales

et al. 2024

Cardiol Young

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Background: Perioperative immunisation administration surrounding congenital heart surgery is controversial. Delayed immunisation administration results in children being at risk of vaccine-preventable illnesses and is associated with failure to complete immunisation schedules. Among children with CHD, many of whom are medically fragile, vaccine-preventable illnesses can be devastating. Limited research shows perioperative immunisation may be safe and effective. Methods: We surveyed Pediatric Acute Care Cardiology Collaborative member centres and explored perioperative immunisation practices. We analysed responses using descriptive statistics. Results: Complete responses were submitted by 35/46 (76%) centres. Immunisations were deferred for any period prior to surgery by 23 (66%) centres and after surgery by 31 (89%) centres. Among those who deferred post-operative immunisation, 20 (65%) required deferral only for patients whose operations required cardiopulmonary bypass. Duration of deferral in the pre- and post-operative periods was variable. Many centres included exceptions to their policy for specific vaccine-preventable illnesses. Almost all (34, 97%) centres administer routine childhood immunisation to patients who remain admitted for prolonged periods. Conclusions: Most centres defer routine childhood immunisation for some period before and after congenital heart surgery. Centre specific practices vary. Immunisation deferral confers risk to patients and may not be warranted in this population. Further research would be necessary to understand the immunologic impact of these practices.

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Effects of cardiopulmonary bypass on immunoglobulin G antibody titres after SARS-CoV2 vaccination

Cited by 4 publications

References 19 publications

Effect of Cardiopulmonary Bypass on SARS‐CoV‐2 Vaccination Antibody Levels

Effect of Cardiopulmonary Bypass on SARS‐CoV‐2 Vaccination Antibody Levels

Optimal timing of SARS-CoV-2 vaccination prior to cardiovascular surgery under cardiopulmonary bypass

Immunisation deferral practices surrounding congenital heart surgery

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