Perioperative management of COVID-19 patients undergoing cardiac surgery with cardiopulmonary bypass

Abstract

Coronavirus disease 2019 (COVID-19) is a serious health concern which affects all healthcare professionals worldwide. The pandemic puts health services, including cardiac surgery units, under escalating pressure. There are significant challenges caused by this novel virus and ensuing disease that leads to great uncertainty. While it has been advocated to delay elective surgeries, most cardiac surgical patients present in a more urgent manner which elevates the critical nature for intervention, which may make the surgical decision inevitable. To date, no definitive treatments to the pandemic have been promoted. Cardiac surgical centers may experience an increasing number of COVID-19 patients in clinical practice. Preparation for managing these patients will require a change in the current modalities for perioperative care. Therefore, the goal of this report is to share our own experiences, combined with a review of the emerging literature, by highlighting principles for the adult cardiac surgery community regarding treatment of patients scheduled for surgery. The following report will recommend perioperative guidance in patient management to include safety precautions for the heart team, the conduct of extracorporeal circulation and related equipment, and covering the early period in intensive care in the context of the current pandemic.

Bleeding Complications in Patients With Perioperative COVID-19 Infection Undergoing Cardiac Surgery: A Single-Center Matched Case-Control Study

“…[2][3][4] In addition, in many cardiothoracic surgery centers, a severe reduction of operated cases has been observed. 1,4,[7][8][9][10] COVID-19 syndrome, putatively caused by coronavirus-2, is frequently characterized by acute respiratory failure with radiological signs of interstitial pneumonia, ground glass opacities and/or bilateral patchy shadowing. In some instances, ARDS and shock may also occur.…”

“…11 A few studies investigating the clinical outcomes of COVID-19 patients undergone undergoing surgery, reported increased morbidity and mortality. 1,[8][9][10] In nine COVID-19 patients undergoing cardiac surgery, Yates et al 1 reported a 44% mortality rate mainly due to severe respiratory failure. SARS-CoV-2 is a pleiotropic virus that causes several different clinical syndromes and changes in laboratory parameters, including thrombocytopenia, lymphocytopenia and a prolonged PT.…”

“…SARS-CoV-2 is a pleiotropic virus that causes several different clinical syndromes and changes in laboratory parameters, including thrombocytopenia, lymphocytopenia and a prolonged PT. [10][11] In addition to respiratory and renal complications, COVID-19 patients may develop coagulation disorders. An increased risk for thromboembolic events has also been documented.…”

“…1,5,[7][8][9] Among coronavirus disease patients, the most frequent complications included interstitial pneumonia with respiratory failure and acute respiratory distress syndrome (ARDS), acute renal failure and thromboembolic events. 1,[6][7][8][9][10][11][12][13][14][15] However, during surgery in COVID-19 patients, perioperative bleeding was less observed, and has not been thoroughly investigated.…”

Urgent Cardiac Surgery and COVID-19 Infection: Uncharted Territory

“…[2][3][4] Extrapolation of observed effects in patients with severe COVID-19 infection is applied to cardiac surgery patients, addressing mainly the observation of hypercoagulability and hyperinflammation. 5 Therefore, reporting experience remains crucial, and participation in a multicentric registry 6 should be greatly encouraged.…”