How does preoperative SARS-CoV-2 time affect outcome parameters in open heart surgery?

Öz

Aim: In the present study, the purpose was to compare the outcome parameters before open heart surgery according to the time of Covid-19 infection in patients who had Covid-19. The primary outcome was 28-day mortality, secondary outcomes were length of stay in the Intensive Care Unit, length of hospital stay, and postoperative complications. Material and Method: Patients, who were over the age of 18, who underwent open heart surgery between July 2021 and August 2022 in Izmir Katip Çelebi University Atatürk Training and Research Hospital Cardiovascular Surgery Clinic, were evaluated retrospectively. Those who had Covid-19 infection that was confirmed with the positivity of Polymerase Chain Reaction (PCR) before the surgery were included in the study. The patients were divided into 3 groups as those who underwent open heart surgery in the first 7 weeks following Covid-19, between 7-24 weeks and following 24 weeks. Patients who did not have preoperative Covid-19, those who underwent beating heart surgery, and patients who had postoperative Covid-19 were excluded from the study. Results: A total of 89 patients were evaluated. The mean age was 59.44±12.2 (23-81) years and 73% (n=58) patients were male. PCR positive-time to surgery was 33.72±25.86 (median 26.43) weeks. No difference was detected in terms of mortality and postoperative complications (bleeding, infection, acute neurological event, revision surgery, blood transfusion) among patients who underwent open heart surgery in the first 7 weeks, between 7-24 weeks and following 24 weeks following the Covid-19 infection. No difference was detected between the groups in terms of duration of anesthesia, duration of surgery, duration of cardiopulmonary bypass, and cross-clamping. It was found that extubation times, hospital stays, and length of stays on mechanical ventilator were higher in patients who underwent open heart surgery 7 to 24 weeks following Covid-19 infection (p= 0.02, p=0.05, p= 0.009). Conclusion: Although it was reported in the literature that surgery 7 weeks following Covid-19 infection is safe in terms of survival and morbidity, it was found in the present study that the duration of extubation, mechanical ventilation and hospital stays were prolonged in patients who were operated at a later period (up to the 24th week). We think that there is a need for further randomized controlled studies to evaluate the late effects of Covid-19 infection in open heart surgery.

Anahtar Kelimeler

• open heart surgery
• post -covid 19
• timing of operation

Kaynakça

1. 1. Fudulu DP, Angelini GD. Cardiac surgery in the time of the coronavirus. J Card Surg. 2020;35:1177-1179.
2. 2. Haft JW, Atluri P, Ailawadi G, Engelman DT, Grant MC, Hassan A, et al. Adult Cardiac Sur-gery During the COVID-19 Pandemic: A Tiered Patient Triage Guidance Statement. Ann Thorac Surg 2020;110:697-700.
3. 3. Sanders J, Akowuah E, Cooper J, Kirmani BH, Kanani M, Acharya M, et al. Cardiac surgery outcome during the COVID-19 pandemic: a ret-rospective review of the early experience in nine UK centres. J Cardiothorac Surg 2021;16:43.
4. 4. El-Boghdadly K, Cook TM, Goodacre T, Kua J, Denmark S, McNally S, et al. Timing of elective surgery and risk assessment after SARS-CoV-2 infection: an update: A multidisciplinary con-sensus statement on behalf of the Association of Anaesthetists, Centre for Perioperative Care, Federation of Surgical Specialty Associations, Royal College of Anaesthetists, Royal College of Surgeons of England. Anaesthesia 2022;77:580-587.
5. 5. COVIDSurg Collaborative; GlobalSurg Collabo-rative. Timing of surgery following SARS-CoV-2 infection: an international prospective cohort study. Anaesthesia 2021;76:748-758.
6. 6. Dayan V, Straneo P, Arguello MJ, Vaca M, Enriquez LE, Krogh G, et al. Joint Recommen-dations 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. Braz J Cardiovasc Surg 2022;37:754-764.
7. 7. Abbott TEF, Fowler AJ, Dobbs TD, Gibson J, Shahid T, Dias P, et al. Mortality after surgery with SARS-CoV-2 infection in England: a popu-lation-wide epidemiological study. Br J Anaesth 2021;127:205-214.
8. 8. COVIDSurg Collaborative. Mortality and pul-monary complications in patients undergoing surgery with perioperative SARS-CoV-2 infec-tion: an international cohort study. Lancet 2020;396:27-38.

9. 9. Şentürk M, El Tahan MR, Shelley B, Szegedi LL, Piccioni F, Licker MJ, et al. Thoracic Anest-hesia during the COVID-19 Pandemic: 2021 Updated Recommendations by the European Association of Cardiothoracic Anaesthesiology and Intensive Care (EACTAIC) Thoracic Subspecialty Committee. J Cardiothorac Vasc Anesth 2021;35:3528-3546.
10. 10. American Society of Anesthesiologists and Anesthesia Patient Safety Foundation Joint Sta-tement on Elective Surgery/Procedures and Anesthesia for Patients After COVID-19 Infec-tion. Published: March 9, 2021 Updated: Feb-ruary 22, 2022; June 20, 2023.
11. 11. Deng JZ, Chan JS, Potter AL, Chen YW, Sandhu HS, Panda N, et al. The Risk of Postoperative Complications After Major Elective Surgery in Active or Resolved COVID-19 in the United States. Ann Surg 2022;275:242-246. 12. COVIDSurg Collaborative. Delaying surgery for patients with a previous SARS-CoV-2 infection. Br J Surg 2020;107:e601-e602.
12. 13. Baiocchi G, Aguiar S Jr, Duprat JP, Coimbra FJF, Makdissi FB, Vartanian JG, et al. Early postoperative outcomes among patients with delayed surgeries following preoperative positi-ve test for SARS-CoV-2: a case-control study from a single institution. J Surg Oncol 2021;123:823-833.
13. 14. Knisely A, Zhou ZN, Wu J, Huang Y, Holcomb K, Melamed A, et al. Perioperative Morbidity and Mortality of Patients With COVID-19 Who Undergo Urgent and Emergent Surgical Proce-dures. Ann Surg 2021;273:34-40.
14. 15. Ismail NA, Jaapar AN, Yunus AM, Sanusi AR, Taib ME, Yakub MA. Outcome of adult cardiac surgery following COVID-19 infection in un-vaccinated population in a national tertiary centre. PLoS One 2022;17:e0266056.