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RESEARCH PRODUCT

Cardiac surgery outcomes in patients with coronavirus disease 2019 (COVID-19): A case-series report

Ettore AugugliaroAlberto MinacapelliChristiano ArganoKhalil FattouchGiulia ZambelliMarco MoscarelliCorrao SalvatoreAngela Nogara

subject

AdultMalePulmonary and Respiratory MedicineSIRS systemic inflammatory response syndromemedicine.medical_specialtyInfectious Disease Transmission Patient-to-ProfessionalCoronavirus disease 2019 (COVID-19)Sars-CoV-2medicine.medical_treatmentSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2)cardiac surgery COVID-19 new coronavirus SARS-CoV-2CRP C-reaction protein030204 cardiovascular system & hematologyHealth Services AccessibilityArticleDisease OutbreaksTertiary Care Centers03 medical and health sciences0302 clinical medicinePostoperative ComplicationsValve replacementInterquartile rangeInternal medicineHealth caremedicineHumansIn patientCardiac Surgical ProceduresAgedAged 80 and overInfection ControlHealth Care RationingTAVR transcatheter aortic valve replacementbusiness.industrynew coronavirusExtracorporeal circulationCOVID-19Middle AgedCardiac surgery030228 respiratory systemItalyRT-PCR t real-time reverse transcription polymerase chain reactionFemaleSurgeryCOVID-19 / Sars-CoV-2 novel coronavirus 2businessCardiology and Cardiovascular Medicinecardiac surgeryFollow-Up Studies

description

Abstract Objective The impact of coronavirus disease 2019 (COVID-19) on the postoperative course of patients after cardiac surgery is unknown. We experienced a major severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak in our cardiac surgery unit, with several patients who tested positive early after surgery. Here we describe the characteristics, postoperative course, and laboratory findings of these patients, along with the fate of the health care workers. We also discuss how we reorganize and reallocate hospital resources to resume the surgical activity without further positive patients. Methods After diagnosis of the first symptomatic patient, surgery was suspended. Nasopharyngeal swabs were performed in all patients and health care workers. Patients who were positive for SARS-CoV-2 were isolated and monitored throughout the in-hospital stay and followed up after discharged until death or clinical recovery. Results Twenty patients were found to be positive for SARS-CoV-2 sometime after cardiac surgery (mean age 69 ± 10.4 years; median European System for Cardiac Operative Risk Evaluation II score 3 [interquartile range, 5.1]); the median time from surgery to diagnosis was 15 days (interquartile range, 11). Among the patients, 18 had undergone cardiac surgery and 2 of them transcatheter aortic valve replacement. Overall mortality was 15%. Specific COVID-19–related symptoms were identified in 7 patients (35%). Among the 12 health care workers infected, 1 developed a bilateral mild-grade interstitial pneumonia. Conclusions COVID-19 infection after cardiac surgery, regardless the time of the onset, is a serious condition. The systemic inflammatory state that follows extracorporeal circulation may mask the typical COVID-19 laboratory findings, making the diagnosis more difficult. A strict reorganization of the hospital resources is necessary to safely resume the cardiac surgical activity.

yearjournalcountryeditionlanguage
2020-10-01
10.1016/j.jtcvs.2020.09.138https://hdl.handle.net/10447/583792