COVID-19 after emergency coronary artery bypass grafting: features of the postoperative course and prognosis

Abstract

Introduction Coronavirus disease (COVID-19) caused by SARS-CoV-2 virus identified in 2019, forces cardiology departments to quickly adapt existing clinical guidelines to the new reality, and this is particularly relevant for scheduling patients with acute coronary syndrome (ACS). The article demonstrates how COVID-19 has affected emergency cardiac surgery care.Objective To analyze the features of completed cases of emergency coronary artery bypass grafting (ECABG) and COVID-19 diagnosed during the postoperative period at the Research Institute – Ochapovsky Regional Hospital no. 1 for the period from May 1, 2020 to February 1, 2021. Material and Methods Completed cases of ECABG have been retrospectively studied. EACS was performed in 145 patients: in 79 people with unstable angina pectoris (NS), in 40 with Q-negative myocardial infarction (MI), in 14 cases with primary Q-positive MI, in 12 patients with recurrent MI. The condition for ECABG was a negative SARS-Cov-2 PCR result and the absence of viral pneumonia by CT. The patients were divided into 2 subgroups. The first one included people with ECABG that were not diagnosed with COVID-19 during postoperative follow-up in the hospital. Subgroup II had patients with ECABG and COVID-19 diagnosed during the hospitalization.Results Contingency tables showed a statistically significant interaction between group membership and mortality, 2.3% (n = 3) in subgroup 1 and 20% (n = 3) in subgroup 2, Pearson’s test χ2 = 10.6, p < 0.05. When analyzing survival rate in the EACS + COVID-19 subgroup, it is worth paying attention to the cumulative proportion of survivors, considering the severity of the course of viral pneumonia. The proportion of such patients with CT-4 by the 32nd day of hospital stay was 0.3.Conclusions Mortality rate in the postoperative course after ECABG with COVID-19 is significantly higher. In patients who underwent ECABG and died in the early and late postoperative period from COVID-19, a new coronavirus infection was diagnosed at a later date. In these cases, a considerably longer duration of CPB and a higher level of ferritin were revealed at the time of transference to the observation department. Survival rate in ECABG patients due to primary Q-negative MI is significantly lower in comparison with patients hospitalized for unstable angina.

Keywords

• acute coronary syndrome
• covid-19
• mortality
• coronary artery bypass grafting
• cardiac surgery
• cardiovascular surgery