Coronary Artery Bypass Surgery in Patients With COVID-19

HomeCirculation: Cardiovascular Quality and OutcomesVol. 14, No. 1Coronary Artery Bypass Surgery in Patients With COVID-19 Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBCoronary COVID-19What Have We Learned? Pedro Silvio Farsky, Diego Feriani, Barbara B.P. Valente, Maria A.G. Andrade, Vivian L. Amato, Larissa Carvalho, Aline S. Ibanes, Luiz F. Godoy, Renato T. Arnoni Cely Abboud FarskyPedro Farsky MD, Av Dante Pazzanese 500, Sao Paulo, SP, CEP 04012-180 Brazil. Email E-mail Address: [email protected] https://orcid.org/0000-0001-7427-3237 Instituto de Cardiologia, São Brazil (P.S.F., D.F., B.B.P.V., M.A.G.A., V.L.A., L.C., A.S.I., R.T.A., C.S.A.). Hospital Israelita Albert Einstein, L.F.G.). Search for more papers by this author , FerianiDiego Feriani https://orcid.org/0000-0002-3733-6048 ValenteBarbara Valente AndradeMaria Andrade AmatoVivian Amato CarvalhoLarissa Carvalho IbanesAline Ibanes GodoyLuiz Godoy https://orcid.org/0000-0002-6918-6865 ArnoniRenato AbboudCely Originally published11 Dec 2020https://doi.org/10.1161/CIRCOUTCOMES.120.007455Circulation: Outcomes. 2021;14:e007455Other version(s) of articleYou are viewing the most recent version article. Previous versions: December 11, 2020: Ahead Print Coronavirus disease 2019 (COVID-19) caused novel coronavirus severe acute respiratory syndrome 2 (SARS-CoV-2) led pandemic, causing unprecedented health social crisis worldwide.Patients with coronary syndromes, especially when artery bypass graft (CABG) surgery is needed, may present higher severity risk if affected COVID-19. Extracorporeal circulation leads activation endothelium microcirculatory network, which activates coagulation, platelet aggregation, inflammation.1 also course inflammation, massive secretion inflammatory cytokines, plaque rupture, a procoagulant state.2 Therefore, it advisable postpone surgeries interventions possible. However, our institution public tertiary referral hospital high-risk cardiovascular patients even SARS-CoV-2 pandemic.We describe series 13 submitted CABG who had infection during same hospitalization, 6 before surgery, 3 were operated active infection, 4 infected after surgery.All admitted multivessel disease, clinical features requiring emergency procedures. By definition cardiac recommendations Patel et al,3 all on high acuity cases not able be discharged.Heart team decisions made infectious evaluation routinely tested reverse-transcriptase polymerase chain reaction 24 48 hours surgery. Positive or nonavailable tests personal protective equipment isolation measures operating room isolated postoperative intensive care unit. During no extracorporeal changes, done COVID-19, ultrafiltration was used. characteristics summarized Table.4,5Table. Patient characteristics.IDAge, ySexComorbiditiesSociety Thoracic Surgeons score mortality scoreCardiological featuresCT findings4Diagnostic interval until dCOVID-19 status at roomCOVID-19 severity5Postoperative complicationPostoperative mechanical ventilation, dPostoperative ICU stay, dRenal replacement therapy hospitalizationHospital length dClinical outcomesPreoperative 168FHYP/DM/HC1.23%Unstable anginaNA21RecoveredAsymptomaticAF16No35Discharge 269FHYP/DM/HC2.94%Non-STEMINA31RecoveredAsymptomaticAF/pulmonary septic shock55Yes35Death 369FHYP/HC/CKD/STK/TIA1.46%Unstable anginaNegative22RecoveredAsymptomaticAF/bleeding plus platelets transfusion34No46Discharge 460MHYP/HC/SM0.76%Unstable anginaNegative24RecoveredAsymptomaticSVT/severe encephalopathy2126No94Death 568FHYP/HC/SM2.00%Unstable anginaNA22RecoveredAsymptomaticNo17No35Discharge 673MHYP/DM/HC/PE2.47%Non-STEMITypical22RecoveredAsymptomaticNo17No38DischargeCOVID-19 intraoperative 764MHYP/DM/HC/PE2.22%Non-STEMI/postinfarction anginaNA1Active diseaseIndeterminateIABP/refratary shock33Yes6Death 857FHYP/DM/HC4.47%Non-STEMI/postinfarction diseaseIndeterminateNo112Yes42Discharge 962FHYP/DM/HC1.22%Unstable anginaAtypical−1Active diseaseCriticalPulmonary shock68No23DischargeCOVID-19 1050MHYP/DM/SM0.48%Non-STEMI/postinfarction anginaIndeterminate−5Pre symptomaticSeverePulmonary thromboembolism13No17Discharge 1163MNA0.70%STEMITypical−6Pre symptomaticSevereNo12No32Discharge 1243MHC/SM1.45%Non-STEMITypical−10Pre symptomaticCriticalBleeding transfusion/preoperate myocardial infarction type 52829No56Discharge 1358FHYP/HC/COPD1.49%STEMINA−13Pre symptomaticModerateBleeding 517No34DischargeAF indicates Atrial fibrillation; CKD, chronic kidney disease; COPD, obstructive pulmonary 2019; CT, computed tomography; DM, diabetes; HC, hypercholesterolemia; HYP, hypertension; IABP, intra aortic balloon pump; ICU, unit; NA, available; PE, embolism; SM, smoking; STEMI, ST-segment–elevation infarction; STK, stroke; SVT, supra ventricular tachycardia; TIA, transient ischemic attack.Patients positive waited least 14 days symptoms resolution. After one died from shock another patient encephalopathy. This encephalopathy T2/fluid-attenuated inversion recovery hyperintense signal hypothalamus diffuse microangiopathic pattern seen brain magnetic resonance imaging. Two other atrial fibrillation complications surgery.Three an emergent basis because instability PCR result available. One others discharged. third day cardiogenic shock. The patient, surgical risk, did develop important manifestations discharged 26 recovered lung origin. She presented mild-lung signs infection.Four negative period, medium time 8.5 CABG. All alive. They developed that ranged moderate severe. embolism, 5 infarction.The authors declare supporting data available within study approved Institutional Review Committee.Emergent stop stable deferred. Since begging specific units wards opened suspected confirmed cases. Visits suspended as companions. But though, infections occurred.To best knowledge, first hospitalization. case description reported only single cases.6,7In series, we found rate mortality. Hypothalamic imaging changes fourth already been described feature resembles Wernicke’s encephalopathy.Although there potential common both they related procedure.A particularly point sufficient resolution symptoms. procedure, disproportionately death complications.In COVID complications.Protective avoid mandatory. learned previous should wait long possible resolution, considering unexpected occur.Sources FundingNone.Disclosures None.FootnotesPedro pedro.[email protected]comReferences1. Kraft F, Schmidt C, Van Aken H, Zarbock A. Inflammatory response circulation.Best Pract Res Clin Anaesthesiol. 2015; 29:113–123. doi: 10.1016/j.bpa.2015.03.001CrossrefMedlineGoogle Scholar2. 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Kuznetsov Gevorgyan Novokshenov Kryukov Polyaeva Lyas Khalmetova Duplyakov D (2021) search optimal strategy, Russian Cardiology, 10.15829/1560-4071-2021-4342, 26, (4342) January 2021Vol Issue 1 Advertisement Article InformationMetrics © 2020 Association, Inc.https://doi.org/10.1161/CIRCOUTCOMES.120.007455PMID: 33302701 publishedDecember KeywordsultrafiltrationCOVID-19acute syndromecytokinespandemicPDF download SubjectsCardiovascular SurgeryComplicationsMortality/Survival