CARDIAC SURGE RY
Patient Sex Age Diagnosis 1 2 3 4
5 6
7 8 9 M 68 Infective endocarditis M 61 STEMI
M 59 Expanding DTA aneurysm
M 45 Infected aortic graft
M 71 Non STEMI M 75 Non STEMI +
pulmonary oedema F F
76 Severe mitral regurgitation
CT chest 69 Severe aortic stenosis CT chest M 63 Unstable angina 10 M 71 STEMI
Swab + CT chest Swab
0 0
1 1
63 50 9 84
Swab + CT chest
Swab Swab + CT chest Swab CT chest 1 1 4
1 0
16 5 18
71 9
Modality of COVID-19 diagnosis
Swab
Number
of positive swabs
4
Delay to surgery (days)
31
Surgery Aortic
valve replacement CABG
DTA replacement
Ascending aorta replacement
CABG
EuroScore II
1.59 1.09 3.91 7.93 1.09
CABG + Mitral valve 7.15 replacement
Mitral repair
Aortic valve replacement
CABG CABG
2.42 3.54
1.03 4.06
Table 1. Demographics, cardiac diagnosis and surgery performed. Details of the COVID-19 screening pre and postoperatively. CABG: Coronary artery bypass grafting; DTA: descending thoracic aorta; STEMI: ST elevation myocardial infarction.
Patient COVID symptoms
1 2 3 4 5 6 7 8 9
10 No
SOB No No No No No No No No
Lowest
Lymphocyte count
0.5 1.0 1.6 0.6 1.9 1.8 2.2 0.4 0.5 1.1
Highest LDH value
350 N/A 177 N/A 216 162 285 249 N/A 160
Highest CT value
37.74 34.15 35.14 37.24 31.63 0 0 0 0
28.08
CT changes suggested of COVID
No Yes No Yes No Yes Yes Yes Yes No
Mechanical ventilation
times (hours)
8 6
24 12 4 4 4 5 4 4
Length of ITU
admission (days)
3 3 4 4 1 1 2 7 1 3
Length of
post-operative stay
(days) 14
5 9
48 4 6 9
12 5 7
Table 2. Presence of COVID-19 symptoms and screening adjuncts: lymphocyte count and Lactate dehydrogenase (LDH) values, non-contrasted chest computed tomography (CT). Postoperative outcomes including length of intensive care (ITU) stay. Ct: cycle threshold; SOB: shortness of breath. N/A (Non-applicable) means the result was not available due to haemolysed sample.
years). Cardiac diagnosis included: acute coronary syndrome (n=5, 50%), acute aortic syndrome (n=1, 11%), decompensated mitral regurgitation (n=1, 11%), symptomatic severe aortic stenosis (n=1, 11%), infective endocarditis (n=1, 11%) and infected aortic graft (n=1, 11%). (Table 1)
All the patients were discussed at the relevant MDT with input from a virologist/ infection specialist. In all cases it was agreed that the optimal treatment was open surgery
OCTOBER 2020
without possibility for a less invasive approach. In four cases, the patients were discharged home with medical therapy and readmitted later for elective surgery. Mean delay to surgery was 67 days (50-84 days). The other six patients required urgent treatment during the same admission. Mean delay to surgery was 14.7 days (4-31 days), having offered surgery as early as four days after a negative swab and one day after radiological resolution of the lung
parenchyma changes. (Tables 1 and 2) They were kept in isolation in a specialised cardiac unit and the COVID-19 swabs were repeated every 48 hours until negative tests were obtained. Two patients tested negative on the first repeated swab, while another two had four subsequent positive swabs. One patient with negative swabs had diffuse ground-glass opacities suggestive of COVID-19 pneumonitis in the non-contrast CT chest. Close monitoring with serial CXR was done until resolution of
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