Early respiratory outcomes following cardiac surgery in patients with COVID‐19

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Abstract

Background

Both coronavirus disease (COVID‐19) and cardiac surgery have a negative impact on pulmonary function. This study aimed to determine the postoperative respiratory outcomes of patients with COVID‐19 who underwent cardiac surgery.

Methods

In this retrospective study, we reviewed and analyzed the patient characteristics and clinical data of 25 asymptomatic patients with COVID‐19 who underwent urgent or emergency cardiac surgery at Tehran Heart Center Hospital, Iran, between 29 February and 10 April 2020.

Results

The mean age, EuroSCORE, and body mass index were 57.3 ± 15.1 years, 6.65 ± 1.29, and 25.7 ± 3.7 kg/m ², respectively. Four patients underwent off‐pump cardiac surgery and 21 underwent on‐pump cardiac surgery with a median cardiopulmonary bypass time of 85 minutes (interquartile range (IQR, 50‐147). The overall mortality rate and the length of stay in the intensive care unit (ICU) were higher compared to those of a propensity‐matched group of patients who underwent cardiac surgery in the pre‐COVID era. The median intubation time was 13 hours (IQR, 9.5‐18), which was comparable to that of pre‐COVID cardiac surgery patients. The readmission rate to the ICU was 16%. In this ICU readmitted group, the mean oxygen index, FiO ₂, and mortality rate were higher and the PaO ₂/FiO ₂ ratio was lower than those of the nonreadmitted patients.

Conclusions

Although early respiratory outcomes of asymptomatic COVID‐19 patients who underwent early cardiac surgery appeared to be satisfactory, compared to the propensity‐scored matched non‐COVID group, the postoperative outcomes were worse, especially in the ICU readmitted patients. We suggest postponing cardiac operations unless the patient requires emergency surgery.

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Most cited references 14

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Clinical Characteristics of Coronavirus Disease 2019 in China

Wei-jie Guan, Zheng-yi Ni, Yu Hu … (2020)

Abstract Background Since December 2019, when coronavirus disease 2019 (Covid-19) emerged in Wuhan city and rapidly spread throughout China, data have been needed on the clinical characteristics of the affected patients. Methods We extracted data regarding 1099 patients with laboratory-confirmed Covid-19 from 552 hospitals in 30 provinces, autonomous regions, and municipalities in mainland China through January 29, 2020. The primary composite end point was admission to an intensive care unit (ICU), the use of mechanical ventilation, or death. Results The median age of the patients was 47 years; 41.9% of the patients were female. The primary composite end point occurred in 67 patients (6.1%), including 5.0% who were admitted to the ICU, 2.3% who underwent invasive mechanical ventilation, and 1.4% who died. Only 1.9% of the patients had a history of direct contact with wildlife. Among nonresidents of Wuhan, 72.3% had contact with residents of Wuhan, including 31.3% who had visited the city. The most common symptoms were fever (43.8% on admission and 88.7% during hospitalization) and cough (67.8%). Diarrhea was uncommon (3.8%). The median incubation period was 4 days (interquartile range, 2 to 7). On admission, ground-glass opacity was the most common radiologic finding on chest computed tomography (CT) (56.4%). No radiographic or CT abnormality was found in 157 of 877 patients (17.9%) with nonsevere disease and in 5 of 173 patients (2.9%) with severe disease. Lymphocytopenia was present in 83.2% of the patients on admission. Conclusions During the first 2 months of the current outbreak, Covid-19 spread rapidly throughout China and caused varying degrees of illness. Patients often presented without fever, and many did not have abnormal radiologic findings. (Funded by the National Health Commission of China and others.)

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Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention

Zunyou Wu, Jennifer M. McGoogan (2020)

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Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy

Giacomo Grasselli, Alberto Zangrillo, Alberto Zanella … (2020)

In December 2019, a novel coronavirus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) emerged in China and has spread globally, creating a pandemic. Information about the clinical characteristics of infected patients who require intensive care is limited.

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Author and article information

Contributors

Khosro Barkhordari:

ORCID: http://orcid.org/0000-0001-9074-2785

kh.barkhordari@gmail.com

Journal

Journal ID (nlm-ta): J Card Surg

Journal ID (iso-abbrev): J Card Surg

Journal ID (doi): 10.1111/(ISSN)1540-8191

Journal ID (publisher-id): JOCS

Title: Journal of Cardiac Surgery

Publisher: John Wiley and Sons Inc. (Hoboken )

ISSN (Print): 0886-0440

ISSN (Electronic): 1540-8191

Publication date (Electronic): 13 August 2020

Electronic Location Identifier: 10.1111/jocs.14915

Affiliations

[ ¹ ] Department of Anesthesiology and Critical Care, Tehran Heart Center Tehran University of Medical Sciences Tehran Iran

[ ² ] Department of Anesthesiology and Critical Care, Sina Hospital Tehran University of Medical Sciences Tehran Iran

[ ³ ] Department of Cardiac Surgery, Tehran Heart Center Tehran University of Medical Sciences Tehran Iran

[ ⁴ ] Food and Drug Bureau Ministry of Health and Medical Education Tehran Iran

[ ⁵ ] Department of Neurobiology Physiology and Behavior, College of Biological Sciences University of California Davis California

[ ⁶ ] Department of Disease Control Tehran Heart Center Tehran Iran

Author notes

[*] [* ] Correspondence Khosro Barkhordari, MD, Department of Anesthesiology and Critical Care, Tehran Heart Center, Tehran University of Medical Sciences, Tehran 1411713138, Iran.

Email: kh.barkhordari@ 123456gmail.com

Author information

Khosro Barkhordari http://orcid.org/0000-0001-9074-2785

Article

Publisher ID: JOCS14915

DOI: 10.1111/jocs.14915

PMC ID: 7436810

PubMed ID: 32789988

SO-VID: 50abd126-ae10-4294-a0be-4c33b981dedc

License:

This article is being made freely available through PubMed Central as part of the COVID-19 public health emergency response. It can be used for unrestricted research re-use and analysis in any form or by any means with acknowledgement of the original source, for the duration of the public health emergency.

History

Date received : 09 May 2020

Date revision received : 13 June 2020

Date accepted : 21 June 2020

Page count

Figures: 0, Tables: 3, Pages: 7, Words: 4227

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