Postoperative management of cardiac and vascular surgery in the period of COVID-19_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

CHANG Shuo ¹ , ZHANG Xinyi ² , HUANG Sheng ² , FAN Yuxin ² ,  PAN Xiangbin ³ ,  WANG Xiaoqi ²

1. Adult Surgery Center, Fuwai Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100037, P. R. China;
2. Adult Surgery Center, Cardiovascular Hospital Affiliated to Kunming Medical University, Fuwai Cardiovascular Hospital, Kunming, 650102, P. R. China;
3. Structural Heart Disease Center, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, P. R. China;

Corresponding author：

PAN Xiangbin, Email: fwtg_pan@126.com; WANG Xiaoqi, Email: ynfw_xiaoqi@126.com

Keywords：

Novel coronavirus pneumonia; coronavirus disease 2019; cardiac and vascular surgery; perioperation

DOI：

10.7507/1007-4848.202302024

Video：

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Objective To explore the postoperative characteristics and management experience of patients with coronavirus disease 2019 (COVID-19) undergoing cardiac and vascular surgery. Methods From December 7, 2022 to January 5, 2023, the patients with COVID-19 who were admitted to Cardiovascular Hospital Affiliated to Kunming Medical University and underwent cardiac and vascular surgery were selected. The clinical history, surgical information, postoperative recovery process and treatment plan were analyzed retrospectively. Results There were 18 patients in this group, including 11 (61.1%) males and 7 (38.9%) females, with an average age of 58.1±10.9 years. There were 7 patients of hypertension, 5 patients of diabetes, 3 patients of respiratory diseases, and 2 patient of chronic renal insufficiency. There were 5 (27.8%) patients receiving emergency operations and 13 (72.2%) elective operations. All the 18 patients underwent cardiac and vascular surgery in the period of COVID-19, and the time between the last positive nucleic acid test and the surgery was 1.50 (1.00, 6.25) days. There were 8 patients of pulmonary imaging changes, including 3 patients with chest patch shadow, 3 patients with thickened and disordered lung markings, and 2 patients with exudative changes before operation. Antiviral therapy was not adopted in all patients before operation. Three patients were complicated with viral pneumonia after operation, including 2 patients with high risk factors before operation, who developed into severe pneumonia after operation, and underwent tracheotomy. One patient with thrombus recovered after anticoagulation treatment. Another patient of mild pneumonia recovered after antiviral treatment. The other 15 patients recovered well without major complications. There was no operation-related death in the whole group. One patient died after surgery, with a mortality rate of 5.6%. Conclusion Patients with COVID-19 are at high risk of cardiac and vascular surgery, and patients with high-risk factors may rapidly progress to severe pneumonia. Patients with preoperative lung imaging changes or other basic visceral diseases should consider delaying the operation. Early antiviral combined with immunomodulation treatment for emergency surgery patients may help improve the prognosis.

Citation： CHANG Shuo, ZHANG Xinyi, HUANG Sheng, FAN Yuxin, PAN Xiangbin, WANG Xiaoqi. Postoperative management of cardiac and vascular surgery in the period of COVID-19. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(7): 967-973. doi: 10.7507/1007-4848.202302024 Copy

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2.	COVIDSurg Collaborative. Timing of surgery following SARS-CoV-2 infection: An international prospective cohort study. Anaesthesia, 2021, 76(6): 748-758.
3.	中华人民共和国国家卫生健康委员会办公厅, 中华人民共和国国家中医药管理局综合司. 新型冠状病毒感染诊疗方案(试行第十版). 中国医药, 2023, 18(2): 161-166.
4.	Faust JS, Du C, Liang C, et al. Excess mortality in Massachusetts during the delta and omicron waves of COVID-19. JAMA, 2022, 328(1): 74-76.
5.	Kollias A, Kyriakoulis KG, Rapti V, et al. Prone positioning in patients with COVID-19: Analysis of multicenter registry data and meta-analysis of aggregate data. In Vivo, 2022, 36(1): 361-370.
6.	Behesht Aeen F, Pakzad R, Goudarzi Rad M, et al. Effect of prone position on respiratory parameters, intubation and death rate in COVID-19 patients: Systematic review and meta-analysis. Sci Rep, 2021, 11(1): 14407.
7.	Langford BJ, So M, Raybardhan S, et al. Bacterial co-infection and secondary infection in patients with COVID-19: A living rapid review and meta-analysis. Clin Microbiol Infect, 2020, 26(12): 1622-1629.
8.	Mihalj M, Mosbahi S, Schmidli J, et al. Providing safe perioperative care in cardiac surgery during the COVID-19 pandemic. Best Pract Res Clin Anaesthesiol, 2021, 35(3): 321-332.
9.	Bilaloglu S, Aphinyanaphongs Y, Jones S, et al. Thrombosis in hospitalized patients with COVID-19 in a New York City health system. JAMA, 2020, 324(8): 799-801.
10.	Chen S, Zhang D, Zheng T, et al. DVT incidence and risk factors in critically ill patients with COVID-19. J Thromb Thrombolysis, 2021, 51(1): 33-39.
11.	Rali P, O'Corragain O, Oresanya L, et al. Incidence of venous thromboembolism in coronavirus disease 2019: An experience from a single large academic center. J Vasc Surg Venous Lymphat Disord, 2021, 9(3): 585-591.
12.	Osman F, Caplin N, Bashir M. COVID-19: The rising cost of cardiac surgery and disease. J Card Surg, 2021, 36(5): 1593-1596.
13.	Deng JZ, Chan JS, Potter AL, et al. The risk of postoperative complications after major elective surgery in active or resolved COVID-19 in the United States. Ann Surg, 2022, 275(2): 242-246.
14.	COVIDSurg Collaborative. Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: An international cohort study. Lancet, 2020, 396(10243): 27-38.
15.	Nguyen TC, Thourani VH, Nissen AP, et al. The effect of COVID-19 on adult cardiac surgery in the United States in 717 103 patients. Ann Thorac Surg, 2022, 113(3): 738-746.

1. Harky A, Harrington D, Nawaytou O, et al. COVID-19 and cardiac surgery: A perspective from United Kingdom. J Card Surg, 2021, 36(5): 1649-1658.
2. COVIDSurg Collaborative. Timing of surgery following SARS-CoV-2 infection: An international prospective cohort study. Anaesthesia, 2021, 76(6): 748-758.
3. 中华人民共和国国家卫生健康委员会办公厅, 中华人民共和国国家中医药管理局综合司. 新型冠状病毒感染诊疗方案(试行第十版). 中国医药, 2023, 18(2): 161-166.
4. Faust JS, Du C, Liang C, et al. Excess mortality in Massachusetts during the delta and omicron waves of COVID-19. JAMA, 2022, 328(1): 74-76.
5. Kollias A, Kyriakoulis KG, Rapti V, et al. Prone positioning in patients with COVID-19: Analysis of multicenter registry data and meta-analysis of aggregate data. In Vivo, 2022, 36(1): 361-370.
6. Behesht Aeen F, Pakzad R, Goudarzi Rad M, et al. Effect of prone position on respiratory parameters, intubation and death rate in COVID-19 patients: Systematic review and meta-analysis. Sci Rep, 2021, 11(1): 14407.
7. Langford BJ, So M, Raybardhan S, et al. Bacterial co-infection and secondary infection in patients with COVID-19: A living rapid review and meta-analysis. Clin Microbiol Infect, 2020, 26(12): 1622-1629.
8. Mihalj M, Mosbahi S, Schmidli J, et al. Providing safe perioperative care in cardiac surgery during the COVID-19 pandemic. Best Pract Res Clin Anaesthesiol, 2021, 35(3): 321-332.
9. Bilaloglu S, Aphinyanaphongs Y, Jones S, et al. Thrombosis in hospitalized patients with COVID-19 in a New York City health system. JAMA, 2020, 324(8): 799-801.
10. Chen S, Zhang D, Zheng T, et al. DVT incidence and risk factors in critically ill patients with COVID-19. J Thromb Thrombolysis, 2021, 51(1): 33-39.
11. Rali P, O'Corragain O, Oresanya L, et al. Incidence of venous thromboembolism in coronavirus disease 2019: An experience from a single large academic center. J Vasc Surg Venous Lymphat Disord, 2021, 9(3): 585-591.
12. Osman F, Caplin N, Bashir M. COVID-19: The rising cost of cardiac surgery and disease. J Card Surg, 2021, 36(5): 1593-1596.
13. Deng JZ, Chan JS, Potter AL, et al. The risk of postoperative complications after major elective surgery in active or resolved COVID-19 in the United States. Ann Surg, 2022, 275(2): 242-246.
14. COVIDSurg Collaborative. Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: An international cohort study. Lancet, 2020, 396(10243): 27-38.
15. Nguyen TC, Thourani VH, Nissen AP, et al. The effect of COVID-19 on adult cardiac surgery in the United States in 717 103 patients. Ann Thorac Surg, 2022, 113(3): 738-746.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Postoperative management of cardiac and vascular surgery in the period of COVID-19

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