Prognostic value of SARS‐CoV‐2 on patients undergoing cardiac surgery

Abstract

Objective: To analyze Italian Cardiac Surgery experience during the pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) identifying risk factors for overall mortality according to coronavirus disease 2019 (COVID-19) status.Methods: From February 20 to May 31, 2020, 1354 consecutive adult patients underwent cardiac surgery at 22 Italian Centers; 589 (43.5%), patients came from the red zone. Based on COVID-19 status, 1306 (96.5%) were negative to SARS-CoV-2 (COVID-N), and 48 (3.5%) were positive to SARS-CoV-2 (COVID-P); among the COVID-P 11 (22.9%) and 37 (77.1%) become positive, before and after surgery, respectively. Surgical procedures were as follows: 396 (29.2%) isolated coronary artery bypass grafting (CABG), 714 (52.7%) isolated non-CABG procedures, 207 (15.3%) two associate procedures, and three or more procedures in 37 (2.7%). Heart failure was significantly predominant in group COVID-N (10.4% vs. 2.5%, p = .01).Results: Overall in-hospital mortality was 1.6% (22 cases), being significantly higher in COVID-P group (10 cases, 20.8% vs. 12, 0.9%, p < .001). Multivariable analysis identified COVID-P condition as a predictor of in-hospital mortality together with emergency status. In the COVID-P subgroup, the multivariable analysis identified increasing age and low oxygen saturation at admission as risk factors for in-hospital mortality. Conclusion:As expected, SARS-CoV-2 infection, either before or soon after cardiac surgery significantly increases in-hospital mortality. Moreover, among COVID-19positive patients, older age and poor oxygenation upon admission seem to be associated with worse outcomes.

Surgical Triage and Timing for Patients With Coronavirus Disease: A Guidance Statement from The Society of Thoracic Surgeons

“…In the event teams pursue cardiac intervention, necessary provisions should be made for appropriate postoperative care given the recognition that patients are likely to incur more medical complications and experience longer intensive care unit length of stay. 26,38,39 EMERGENT INTERVENTION. If the procedure is deemed emergent or if procedural indication becomes emergent during the period of procedural delay, it is advisable to proceed immediately with the intervention, assuming teams observe the necessary precautions to avoid disease transmission, which are outlined in full in prior guidelines.…”

Safety of Surgery Among Asymptomatic SARS‐CoV‐2 PCR‐Positive Patients: A Single‐Center Retrospective Cohort Study

“…However, emergency surgery and a positive SARS2 PCR test only marginally affected adverse outcomes. One study found that age and being SARS2 PCR positive had a significant prognostic value in cardiac surgery [ 13 ]. However, in this study, most patients were symptomatic, and a history of heart failure was more common among PCR-positive patients.…”

Impact of COVID-19 on incidence and outcomes of post-infarction mechanical complications in Europe

“…Finally, concerning the subjects belonging to the COVID-19 era group (for whom COVID-19 screening test was available), 2 patients tested positive for COVID-19 on hospital admission: one survived and the other didn’t. Even if recent studies have described a significantly higher mortality for COVID-19-positive patients undergoing cardiac surgery, such small numbers make any further conclusion unfeasible [ 30 ]. Moreover, only one patient got COVID-19 infection during hospital stay, that later represented the cause of death.…”