Department of Cardiac Surgery, Centro Cardiologico Monzino, Milan, Italy.
Department of Cardiac Surgery, S. Croce Hospital, Cuneo, Italy.
J Card Surg. 2022 Jan;37(1):165-173. doi: 10.1111/jocs.16106. Epub 2021 Oct 30.
To analyze Italian Cardiac Surgery experience during the pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) identifying risk factors for overall mortality according to coronavirus disease 2019 (COVID-19) status.
From February 20 to May 31, 2020, 1354 consecutive adult patients underwent cardiac surgery at 22 Italian Centers; 589 (43.5%), patients came from the red zone. Based on COVID-19 status, 1306 (96.5%) were negative to SARS-CoV-2 (COVID-N), and 48 (3.5%) were positive to SARS-CoV-2 (COVID-P); among the COVID-P 11 (22.9%) and 37 (77.1%) become positive, before and after surgery, respectively. Surgical procedures were as follows: 396 (29.2%) isolated coronary artery bypass grafting (CABG), 714 (52.7%) isolated non-CABG procedures, 207 (15.3%) two associate procedures, and three or more procedures in 37 (2.7%). Heart failure was significantly predominant in group COVID-N (10.4% vs. 2.5%, p = .01).
Overall in-hospital mortality was 1.6% (22 cases), being significantly higher in COVID-P group (10 cases, 20.8% vs. 12, 0.9%, p < .001). Multivariable analysis identified COVID-P condition as a predictor of in-hospital mortality together with emergency status. In the COVID-P subgroup, the multivariable analysis identified increasing age and low oxygen saturation at admission as risk factors for in-hospital mortality.
As expected, SARS-CoV-2 infection, either before or soon after cardiac surgery significantly increases in-hospital mortality. Moreover, among COVID-19-positive patients, older age and poor oxygenation upon admission seem to be associated with worse outcomes.
分析意大利在严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）大流行期间的心脏外科学经验，根据 2019 年冠状病毒病（COVID-19）状态确定总死亡率的危险因素。
2020 年 2 月 20 日至 5 月 31 日，22 家意大利中心的 1354 例成年患者连续接受心脏手术；589 例（43.5%）患者来自红区。根据 COVID-19 状态，1306 例（96.5%）患者 SARS-CoV-2 检测结果为阴性（COVID-N），48 例（3.5%）患者 SARS-CoV-2 检测结果为阳性（COVID-P）；在 COVID-P 组中，有 11 例（22.9%）和 37 例（77.1%）患者分别在术前和术后检测结果为阳性。手术程序如下：396 例（29.2%）孤立性冠状动脉旁路移植术（CABG）、714 例（52.7%）孤立性非 CABG 手术、207 例（15.3%）两个联合手术、37 例（2.7%）三个或更多手术。COVID-N 组心力衰竭明显更为常见（10.4%比 2.5%，p=0.01）。
总住院死亡率为 1.6%（22 例），COVID-P 组显著更高（10 例，20.8%比 12 例，0.9%，p<0.001）。多变量分析确定 COVID-P 状况是住院死亡率的预测因素，与紧急状态一起。在 COVID-P 亚组中，多变量分析确定年龄增加和入院时低氧饱和度是住院死亡率的危险因素。
如预期的那样，SARS-CoV-2 感染，无论是在心脏手术之前还是之后不久，都会显著增加住院死亡率。此外，在 COVID-19 阳性患者中，年龄较大和入院时氧合不良似乎与预后较差相关。
