ABSTRACT
Solid-organ transplantation recipients were assumed highly vulnerable to coronavirus disease 2019 (COVID-19). However, the results of previous studies in patients with orthotopic heart transplantation (OHT) under immunosuppressive therapy are contradictory. Therefore, we aimed to assess the prevalence of COVID-19 infection and associated risk factors, along with the six-month outcomes in COVID-19 positive OHT patients. This single-center telephone-based survey was conducted on OHT patients. Using a detailed questionnaire, exposure to COVID-19, related symptoms, and preventive self-care measures were collected. Outcomes of COVID-19-positive patients were reassessed using another survey six months later. 118 OHT patients (male: n=87, 73.7%) were included with a mean age of 45.3±13.1 years. Sixteen patients (13.5%) reported one or more symptoms compatible with COVID-19, of whom 12 (10.2%) tested positive. Our results indicated no statistically significant association between COVID-19 and comorbidities. Poor adherence to self-care measures and contact with positive index cases were both significantly associated with COVID-19 infection (P<0.001). A later six months follow-up showed that two out of 12 (16.6%) COVID-19 positive OHT patients died. There was no statistically significant difference between the prevalence of COVID-19 in our patients compared to Iran’s general population (P=251.0). Non-compliance with personal protective protocols and a history of contact with COVID-19 cases were the most risk factors for COVID-19 infection in OHT patients.
ABSTRACT
BACKGROUND: The Coronavirus disease 2019 (COVID-19) was declared a worldwide pandemic in 2020 by the World Health Organization (WHO). Certain individuals are at higher risk, (age > 65 years, pre-existing lung or heart conditions, diabetes and obesity) especially those requiring cardiac surgery, including Coronary Artery Bypass Grafting (CABG). Here we present a case series of 11 patients, operated between April 2020 and April 2022, all of whom had recently recovered from COVID-19, who presented with unstable angina, and therefore required urgent Coronary Artery Bypass Grafting (CABG). Similar cases reported in the past, have had a high morbidity and mortality rate. CASE PRESENTATION: The study included 11 males, and their age varied between 53 and 68 years (median of 65 years). They were either partially or fully vaccinated. All of them had a history of recent mild COVID-19 infection. The European system for cardiac operative risk evaluation, EuroSCORE II in-hospital mortality risk at admission, varied between 1.48% and 5.12%. Six out of 11 patients (54.55%) had a recent Acute Coronary Syndrome (ACS) which is associated with a higher risk and poor prognosis. All of them underwent urgent CABG (10 of them, 90.91% cases, using the off-pump technique and one patient had to be converted to the on-pump beating heart surgery technique during surgery). Ten of the 11 patients were operated using the off-pump technique, and there was one death (9.09%). All surviving patients made an uneventful recovery and have been followed up with a median follow-up period of 12 months. CONCLUSIONS: Previous studies on a similar group of patients have resulted in high morbidity and mortality. A conscious effort was made to perform all surgeries off-pump, thereby eliminating the inflammatory effects and other hazards of cardiopulmonary bypass in this case series, with only one out of 11 (9.09%) being converted to the on-pump beating heart technique due to the hemodynamic instability faced during surgery. Our findings show a mortality rate of 9.09%, with the surviving patients doing well at a median follow-up period of 12 months, suggesting that it is a safe procedure in this patient subset.
ABSTRACT
Aim and objective: Post COVID double valve and bypass surgery in Covid pandemic. Materials and methods: We have done 260 cardiac surgery in our hospital out of which 10 case are post COVID case 8 case CABG I case CABG and DVR and one case MVR. All cases we have done 6 weeks after COVID report negative. We have a bundle of pre anaesthasia investigations for all patients, RT PCR negative report, CPP, ESR SGOT SGPT PTI total protein urea creatine HB TLC DLC platelet count MCV C MCH COK MB TROPI HS ECG X-ray chest CT scan - chest echo angiography and complete systemic body evaluation by team of cardiac anaesthesiologist all CABG we have done on beating heart DVR and CAGB on cardiopulmonary bypass all case discharge on 8th day there is no mortality in all our case in non-COVID CABG we got to post bypass surgery patient become positive one PT we lost she was 75-year-old female on 23rd day. We recommend for all cardiac surgery patients should undergo complete PAC and beating heart surgery for coronary artery surgery and all team member should use COVID precaution protocol. Results: We have done total 260 cardiac surgery from may 2020 till August 2021 10 case are post COVID 8 case CABG and 1 mitral valve surgery 1 case double valve surgery and bypass surgery one of 1st in world all post COVID patient discharge on 8th day no mortality in our post COVID case out of 260 cardiac case two patient become covid positive one patient we lost. We advise post-COVID case we should do cardiac elective case 6 week after COVID negative report and complete PAC is very important and every one take all COVID preventive protocol every time. Conclusion: All post COVID case we should do cardiac surgery 6 week after COVID complete PAC evaluation is very important every time COVID prevention protocol for every in hospital for coronary artery bypass surgery beating heart surgery is safe technique.
ABSTRACT
BACKGROUND: Cases of COVID-19 presenting after elective cardiac surgery are rare. Published literature suggests that such cases have a high morbidity and mortality rate. Here, we report a case of COVID-19 presenting after an elective, isolated off-pump coronary artery bypass (OPCAB). CASE PRESENTATION: A 65-year-old obese, hypertensive, hypothyroid lady, with moderate left ventricular dysfunction, presenting with unstable angina, tested negative for COVID-19 at admission, having undergone thrombolysis for a recent inferior wall myocardial infarction, at an outside centre, and coronary angiography revealing left main triple vessel disease, developed signs and symptoms of COVID-19, four days after OPCAB. She was diagnosed with moderate COVID-19 infection. Subsequent contact tracing revealed that her husband was suffering from mild COVID-19 infection and was managed in home isolation. Isolation and early supportive management with moist oxygen, steroids, intravenous antibiotics, zinc and vitamin C helped the patient recover. She was followed up at one month, six months, one year and at eighteen months and has been doing well. CONCLUSIONS: A strong clinical suspicion and repeat testing for COVID-19 is required as the diagnosis may often be missed with COVID-19 mimicking the signs and symptoms of post-cardiotomy syndrome. Preferentially dealing with such cases off-pump, thereby avoiding cardio pulmonary bypass-related complications, may improve outcomes. Isolation and early supportive management help. Adequate follow-up is required in all such cases as cardiovascular complications are common, alongside known long-term sequelae, like anxiety, depression, cardio-respiratory complications, venous thromboembolism and even postural orthostatic tachycardia syndrome.
ABSTRACT
Every year we see an increase in the number of patients with indications for surgical treatment of coronary artery disease. In addition to the difficulties of the cardiac surgery process, no less important is the therapeutic support of patients, which in addition to cardiac subtleties requires guidance in concomitant nosologies. As the age of patients increases, there is a higher comorbidity which is associated with difficult management of patients, extensive prescription of drugs and higher cost of medical care. The aim. To analyze the current literature data on comorbidity in patients hospitalized for coronary artery bypass grafting. Results. According to the literature data, there is a high Charlson comorbidity index, in average 5.7 ± 1.7, in the baseline status of patients with coronary artery disease. High comorbidity index is known for its negative effect on the functioning of grafts in the long-term period after surgical myocardial revascularization. Among patients who underwent surgical revascularization of the myocardium, 22.8-46.9% had diabetes mellitus, 37.5% had obesity, 1.1% had rheumatoid arthritis and 10-12% suffered from chronic kidney disease. There is no statistical data on preoperative status of gastrointestinal tract, but the main complications and predictors of death were identified. Due to the increase in the occurrence of autoimmune diseases on the background of the COVID-19 pandemic, an increase in the number patients with connective tissue diseases in cardiac surgery is predicted, and perioperative management of such patients has its own characteristics and requires further in-depth study. Conclusions. Searching for comorbidity in cardiac surgery patients with coronary artery disease is an important component of their preoperative preparation and risk stratification. The influence of type 2 diabetes mellitus, obesity, autoimmune diseases, chronic kidney disease on the occurrence of postoperative complications and the result of surgical myocardial revascularization has been proven. SARS-CoV-2 infection in the surgical treatment of coronary artery disease is another challenge of today that requires further observation and research to help address prognosis, complications, and mortality. © 2021 The Authors.