Department of Cardiothoracic Surgery, Institut Jantung Negara, Kuala Lumpur, Malaysia.
PLoS One. 2022 Apr 11;17(4):e0266056. doi: 10.1371/journal.pone.0266056. eCollection 2022.
Ever since COVID-19 was declared a pandemic, the world medical landscape has changed dramatically. As cardiac surgeons we not only have the duty to protect our patients and staff from COVID-19 infection, but we are also tasked with the responsibility to ensure those cardiovascular patients awaiting surgery are not harmed from an extended delay in surgery as the world comes to a halt from COVID-19. Currently there is limited literature on the outcome of cardiac surgery in the pre-operative Covid positive group. In this study we aim to assess the safety and outcome of patients undergoing cardiac surgery following Covid-19 infection.
This was a single centre retrospective observational study. All patients undergoing open heart surgery at Institut Jantung Negara from June 2020 to July 2021 were included in this study. Patients who were Covid positive pre-operatively were identified. Data from patient medical records collected contemporaneously were reviewed and analysed, supplemented by telephone call interviews after discharge.
2368 patients underwent open heart surgery from June 2020 until July 2021 in our centre. Of these, 0.5% (12 patients) were identified as Covid positive pre-operatively. Mean age of patients were 59.1 ± 14.8 years old. Mean Ejection Fraction was 46.4 ± 12.9. Most patients (75%) were asymptomatic with covid infection and only one patient were admitted to hospital for Covid infection. Mean duration from Covid PCR positive swab to surgery were 46.3 ± 32.7days. Most of the patients (66.7%) underwent operation on an emergency or urgent basis. Median time to extubation was 1 day. Median ICU length of stay was 1 day. 25% patients required non-invasive ventilation post-operatively and one patient was discharged home on long term oxygen therapy. There were 2 deaths- none of which were covid related mortality.
Cardiac surgery could be performed safely in patients with pre-operative Covid-19 infection after a period of recovery, especially in the asymptomatic to mild category of infection. Multi-disciplinary team approach may be useful in deciding the timing of surgery for complex cases.
自从 COVID-19 被宣布为大流行以来，世界医学领域发生了巨大变化。作为心脏外科医生，我们不仅有责任保护患者和工作人员免受 COVID-19 感染，还承担着确保那些等待手术的心血管病患者不因 COVID-19 导致全球停摆而手术延迟受到伤害的责任。目前，关于术前 COVID-19 阳性患者心脏手术结果的文献有限。在这项研究中，我们旨在评估 COVID-19 感染后接受心脏手术患者的安全性和结果。
这是一项单中心回顾性观察性研究。本研究纳入了 2020 年 6 月至 2021 年 7 月期间在国家心脏研究所接受心脏直视手术的所有患者。确定了术前 COVID-19 阳性的患者。同时回顾和分析了从患者病历中收集的数据，并在出院后进行了电话访谈。
在我们中心，2020 年 6 月至 2021 年 7 月期间有 2368 例患者接受了心脏直视手术。其中，术前 COVID-19 阳性的患者占 0.5%（12 例）。患者平均年龄为 59.1 ± 14.8 岁。平均射血分数为 46.4 ± 12.9。大多数患者（75%）无症状感染 COVID-19，仅有 1 例患者因 COVID-19 住院。从 COVID-19 PCR 阳性拭子到手术的平均时间为 46.3 ± 32.7 天。大多数患者（66.7%）为急诊或紧急手术。中位拔管时间为 1 天。中位 ICU 住院时间为 1 天。25%的患者术后需要无创通气，1 例患者因长期氧疗出院回家。有 2 例死亡，均与 COVID-19 无关。
在恢复期后，心脏手术可安全地用于术前 COVID-19 感染的患者，尤其是在无症状至轻度感染的情况下。多学科团队的方法可能有助于决定复杂病例的手术时机。
