Outcome of adult cardiac surgery following COVID-19 infection in unvaccinated population in a national tertiary centre

Abstract

Background Ever since COVID-19 was declared a pandemic, the world medical landscape has changed dramatically. As cardiac surgeons we not only have the duty to protect our patients and staff from COVID-19 infection, but we are also tasked with the responsibility to ensure those cardiovascular patients awaiting surgery are not harmed from an extended delay in surgery as the world comes to a halt from COVID-19. Currently there is limited literature on the outcome of cardiac surgery in the pre-operative Covid positive group. In this study we aim to assess the safety and outcome of patients undergoing cardiac surgery following Covid-19 infection. Patients and methods This was a single centre retrospective observational study. All patients undergoing open heart surgery at Institut Jantung Negara from June 2020 to July 2021 were included in this study. Patients who were Covid positive pre-operatively were identified. Data from patient medical records collected contemporaneously were reviewed and analysed, supplemented by telephone call interviews after discharge. Results 2368 patients underwent open heart surgery from June 2020 until July 2021 in our centre. Of these, 0.5% (12 patients) were identified as Covid positive pre-operatively. Mean age of patients were 59.1 ± 14.8 years old. Mean Ejection Fraction was 46.4 ± 12.9. Most patients (75%) were asymptomatic with covid infection and only one patient were admitted to hospital for Covid infection. Mean duration from Covid PCR positive swab to surgery were 46.3 ± 32.7days. Most of the patients (66.7%) underwent operation on an emergency or urgent basis. Median time to extubation was 1 day. Median ICU length of stay was 1 day. 25% patients required non-invasive ventilation post-operatively and one patient was discharged home on long term oxygen therapy. There were 2 deaths- none of which were covid related mortality. Conclusion Cardiac surgery could be performed safely in patients with pre-operative Covid-19 infection after a period of recovery, especially in the asymptomatic to mild category of infection. Multi-disciplinary team approach may be useful in deciding the timing of surgery for complex cases.

Joint Recommendations From The Latin American Association of Cardiac and Endovascular Surgery (LACES) and The Cardiovascular Anesthesia Committee of The Latin American Confederation of Anesthesia Societies (CLASA) on the Timing for Cardiac Surgery After COVID-19 Infection

“…Similarly, the percentage of emergency surgeries was significantly higher in the group of patients operated on within 10 days (45.9% vs. 13.3%) of diagnosis. Ismail et al [ 15 ] data, although coming from a smaller group of patients, point towards the same direction.…”

“…Three of them corresponded to prospective articles [ 1 , 7 , 9 ] , and the rest were retrospective [ 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 ] ). Among the prospective studies, the COVID-19Surg [ 1 ] is the largest prospective registry and included all kinds of surgeries.…”

“…The publication by Carrier et al [ 7 ] is a small prospective study of non-cardiac surgeries. From all the included studies, only six of them included patients who underwent cardiac surgery [ 1 , 10 , 13 , 14 , 15 , 17 ] . Among these, only Gomes et al [ 13 ] and Ismail et al [ 15 ] were specific for cardiac surgery.…”

“…Ismail et al [ 15 ] analyzed the results of a group of patients undergoing cardiac surgery with a history of COVID-19 before immunization. Although only 12 patients were included, their results show that after an average of 46 days between infection and surgery, operative mortality was similar to that of their patients without COVID-19, and an increased requirement for non-invasive ventilation was evidenced after extubation.…”

COVID-19 Adult Patients Undergoing Cardiac Surgery: Early Outcomes

“…Similarly, in the study of 12 COVID-19 positive patients in Jantung Negara Institute, the mean time to extubation was one day. However, the hospital stay after surgery was 9 days and there was no COVID-19 related mortality (16) . While, in Wuhan study, 20.5% of patients died after admission to the ICU (10) .…”