Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Oct;272(4):e275-e279.
doi: 10.1097/SLA.0000000000004393.

Clinical Course of COVID-19 Infection in Patients Urgently Operated of Cardiac Surgical Procedures

Andrea Garatti  1   2 , Serenella Castelvecchio  1 , Andrea Daprati  1 , Raffaella Molfetta  1 , Marianna Volpe  1 , Carlo De Vincentiis  1 , Alessandro Parolari  3 , Lorenzo Menicanti  1
Affiliations

Clinical Course of COVID-19 Infection in Patients Urgently Operated of Cardiac Surgical Procedures

Andrea Garatti et al. Ann Surg. 2020 Oct.

Abstract

Objective: The aim of this study was to describe the clinical course of a consecutive series of patients operated of urgent cardiac surgery during COVID-19 outbreak.

Background: In Italy, COVID outbreak has mostly occurred in the metropolitan area of Milan, and in the surrounding region of Lombardy, and previously "conventional" hospitals were converted into COVID spokes to increase ICU beds availability, and to allow only urgent CS procedures.

Methods: Among urgent CS patients (left main stenosis with unstable angina, acute endocarditis, valvular regurgitation with impending heart failure), 10 patients (mean age = 57 ± 9 years), despite a negative admission triage, developed COVID-pneumonia postoperatively, at a median of 7 days after CS.

Results: Patients showed typical lymphopenia, higher prothrombotic profile, and higher markers of inflammation (ferritin and interleukin-6 values). At the zenith of pulmonary distress, patients presented with severe hypoxia (median PaO2/FIO2 ratio = 116), requiring advanced noninvasive ventilation (Venturi mask and continuous positive airway pressure) in the majority of cases. All patients were treated with hydroxychloroquine, azithromycin, and low-molecular-weight heparin at anticoagulant dose. Overall in-hospital mortality was 10% (1/10), peaking 25% in patients who developed COVID pneumonia immediately after CS. The remaining patients, with late infection, were all discharged home without oxygen support, at a median of 25 days after symptom onset.

Conclusions: As postoperative mortality in case of COVID pneumonia is not negligible, meticulous rules (precise triage, safe hospital path, high level of protection for health-care teams, prompt diagnosis of suspicious symptoms) should be strictly followed in patients undergoing CS during COVID pandemic. The role of therapies alternative to CS should be further assessed.

PubMed Disclaimer

References

    1. Bonalumi G, di Mauro M, Garatti A, et al. The COVID-19 outbreak and its impact on hospitals in Italy: the model of cardiac surgery. Italian Society for Cardiac Surgery Task Force on COVID-19 Pandemic. Eur J Cardiothorac Surg 2020; 57:10251028.
    1. McGonagle D, Sharif K, O’Regan A, et al. The role of cytokines including interleukin-6 in COVID-19 induced pneumonia and macrophage activation syndrome-like disease. Autoimmun Rev 2020; 19:102537.
    1. Ranucci M, Ballotta A, Di Dedda U, et al. The procoagulant pattern of patients with COVID-19 acute respiratory distress syndrome. J Thromb Haemost 2020; 18:17471751.
    1. Parolari A, di Mauro M, Bonalumi G, et al. Safety for all: coronavirus disease 2019 pandemic and cardiac surgery: a roadmap to ’phase’ 2. Eur J Cardiothorac Surg 2020.
    1. Chua F, Armstrong-James D, Desai SR, et al. The role of CT in case ascertainment and management of COVID-19 pneumonia in the UK: insights from high-incidence regions. Lancet Respir Med 2020; 8:438440.

MeSH terms