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 Table of Contents  
Year : 2022  |  Volume : 8  |  Issue : 1  |  Page : 22-29

Postoperative outcomes of cardio-thoracic surgery in post-COVID versus non-COVID patients - Single-center experience

Department of Cardiothoracic and Vascular Surgery, Lisie Heart Institute, Kochi, Kerala, India

Date of Submission27-Nov-2021
Date of Decision14-Feb-2022
Date of Acceptance15-Mar-2022
Date of Web Publication26-Apr-2022

Correspondence Address:
Jose Chacko Periappuram
Department of Cardiothoracic and Vascular Surgery, Lisie Heart Institute, Kochi, Kerala
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jpcs.jpcs_66_21

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Objective: The aim of this study is to investigate the postoperative outcomes in post COVID versus non-COVID patients undergone cardiac surgery. Materials and Methods: A retrospective cohort study to analyze the impact of COVID-19 in patients undergoing elective or emergency cardiac surgeries. A total of 512 patients were included in the study over a period of 6 months. The study consists of 35 post-COVID patients and 477 non-COVID patients. All data were collected from previous medical records and hospital database. The clinical outcomes and mortality of post-COVID patients were compared with a cohort of non-COVID patients. The endpoints were compared using t-test or Chi-squared test. Results: Among the post-COVID patients, 54.3% (19) of the post-COVID patients were under COVID category A followed by category B 28.6% (10) and category C 17.1% (6). About 50% of post-COVID patients had complications, especially pneumonia and myocardial infarction following COVID-19. Around 43% of patients showed fibrotic changes in computed tomography (CT) Thorax at the time of admission for surgery. 63% showed CT score in between 1 and 5. The mean COVID antibody titer was 158 U/ml. Majority of the surgeries were coronary artery bypass graft and significant difference was observed in the requirement of intra-aortic balloon pump in post-COVID patients (P < 0.0001). No postoperative mortality reported in post-COVID patients. The postoperative outcomes and survival rates were almost similar in both groups. Conclusion: In our study, the post-COVID patients were recover in a similar way as non-COVID patients after cardiac surgery.

Keywords: Cardiac surgery, post COVID patients, postoperative outcomes

How to cite this article:
Thomas JJ, Philipose S, Vijayan A, Mohammed YP, Padmanabhan M, George A, Wilson J, George GM, Abraham J, Sunil G S, Ranganathan B, Periappuram JC. Postoperative outcomes of cardio-thoracic surgery in post-COVID versus non-COVID patients - Single-center experience. J Pract Cardiovasc Sci 2022;8:22-9

How to cite this URL:
Thomas JJ, Philipose S, Vijayan A, Mohammed YP, Padmanabhan M, George A, Wilson J, George GM, Abraham J, Sunil G S, Ranganathan B, Periappuram JC. Postoperative outcomes of cardio-thoracic surgery in post-COVID versus non-COVID patients - Single-center experience. J Pract Cardiovasc Sci [serial online] 2022 [cited 2023 Mar 30];8:22-9. Available from: https://www.j-pcs.org/text.asp?2022/8/1/22/344135

  Introduction Top

The WHO declared (COVID-19) outbreak as a pandemic in March 11, 2020, and reiterated the call for countries to take immediate actions and scale up response to treat, detect, and reduce transmission to save people's lives. As per statistics of February 11, 2022, 404,910,528 confirmed cases of COVID-19, including 5,783,776 deaths were reported to WHO.[14] The novel virus is more transmissible than the Coronavirus that caused severe acute respiratory syndrome (SARS) and has infected more than ten times the number of SARS patients.[1] The data about different cardiac surgeries in post COVID patients are limited, and the management of such patients is a major concern after the surgery. Studies showed that COVID-19 may lead to plaque instability and myocardial ischemia, a common cause of death in COVID-19 patients.[2] Nowadays, most of the hospitals were overwhelmed with COVID patients and made rearrangements in their hospital resources and infrastructure to meet the surge in COVID-19 cases. It is difficult to predict the postoperative outcomes of cardiac surgery in post-COVID patients because of the long-term effect and multi-organ involvement of COVID-19. Prior studies suggest an increased risk of mortality in COVID-19 patients who underwent surgery, whereas another study states that intensive care unit (ICU) admission rates and mortality are similar to the non-COVID surgical patients.[3] Moreover, few data are available on the effect of COVID-19 in patients undergoing cardiac surgery procedures. Performing elective or emergency cardiac surgery is a major challenge during COVID-19 pandemic. The testing on all surgical patients, preoperatively can also help in the containment of the disease and decrease the risks to patients and healthcare workers without adding much cost to the surgery.[4],[7] Our hospital performs around a thousand cardiac surgeries per year, but none of the patients acquired COVID 19 from the hospital during the study. Hospitals established new policies and guidelines to contain the spread of virus within premises. The aim of this study is to describe the baseline characteristics, postoperative course, and clinical outcomes of cardiac surgery in patients who had a history of COVID-19 preoperatively.

Aims and objectives

The primary objective is to compare the postoperative clinical outcomes and survival rate in post-COVID and non-COVID patients following diverse cardiac surgeries over a period of 6 months. The postoperative outcomes include ventilation time, length of ICU stay, duration of inotropic support, and postoperative hospital stay. The secondary objective is to describe the baseline characteristics, postoperative course in patients who had COVID-19 preoperatively. The baseline characteristics of post-COVID patients include, their COVID category, COVID complications or post COVID sequelae during COVID 19, and their COVID antibody titer, computed tomography (CT) score, and pulmonary function test (PFT) at the time of admission for surgery.

  Materials and Methods Top

This is a retrospective cohort study conducted in a major cardio-thoracic and vascular surgery hospital, in Ernakulam, Kerala, India. This study includes the patients from January 2021 to June 2021. In our study, the post-COVID patients are defined “all patients referred to us for cardiac surgery with a previous history of COVID-19. All patients admitted for elective or emergency cardiac surgery were screened for this study, and categorized as post-COVID and non-COVID patients. Patients with a history of COVID 19 within 6 months prior to cardiac surgery were included in the post-COVID cohort and others were excluded. The non-COVID cohort constitutes patients who do nnot have any COVID history and underwent cardiac surgery during the study period. The baseline characteristics and clinical data of the subjects were collected from previous medical records. In patients with a history of SARS Cov-2, mandatory CT-Thorax, and COVID-19 antibody test were performed at the time of admission for surgery and the data were collected from hospital database. These tests were not performed in non-COVID patients unless it was found to be necessary. Among the 35 post COVID patients, 4 cases were found to be COVID positive during the preoperative workup, 3 patients were treated at our isolation ward, one was sent back to home for isolation. The remaining post-COVID patients were admitted to another hospital or under domiciliary treatment during COVID19, later they were referred to our hospital for cardiac surgery. Their COVID category, treatment details, and complications during or following COVID-19 were collected from previous medical records. Emergency surgeries were performed after a negative antigen test using full PPE and under necessary precautions. All patients received routine postoperative care and monitoring in the cardiothoracic ICU. Ventilator parameters were adjusted according to their hemodynamics, respiratory and arterial blood gas indices. Later, patients were extubated according to their clinical status. The duration of ICU stay, ventilation time, re-exploration rate, inotropic requirement, duration of postoperative hospital stay, and immediate postoperative complications were collected from the respective patient files. As per our hospital protocol, patients who had COVID-19 preoperatively were taken up for surgery after a 1–2 months' period of COVID-19 negative test, except for those who needed earlier surgery due to the severity of their disease. Hospital criteria were 2 months at the initial phase of COVID but later an evidence-based changes were done and currently the period has been set to 10 days after being COVID negative (7 days for quarantine and 3 days for review). Post-COVID period is defined as the difference between date of surgery and date of COVID negative. The clinical outcomes and mortality of post-COVID patients were compared with a cohort of non-COVID patients. The end points compared using t-test or Chi square test. The follow-up details were collected from the patient file or through telephone.

Statistical analysis

The results were presented as mean, median, and percentages. Categorical data were expressed as frequency distributions and percentages, compared using Chi-squared test. Continuous variables presented as mean ± standard deviation or median (range) and compared using t-test or Chi-squared test. P < 0.05 is considered statistically significant.

  Results Top

Clinical characteristics of post COVID patients

There were 35 post-COVID patients admitted for cardiac surgery with a mean post-COVID period of 61 days (Minimum of 11 days and Maximum of 189 days) [Figure 1]. Post-COVID period is defined as the difference between the day of COVID negative and date of surgery. Majority of the post-COVID patients had post-COVID status of <75 days. Eighty-six percent of subjects had one or more comorbidities; Type 2 diabetes mellitus (60%) and hypertension (57.14%) were most common[5] followed by dyslipidemia (31.42%), hypothyroidism (8.60%), chronic kidney disease (5.71%), and chronic obstructive pulmonary disease (5.71%). Eighty-three percent of patients had coronary artery disease and around half of them had recent Acute Coronary Syndrome. A patient with congenital heart disease had aortic regurgitation, restrictive perimembranous ventricular septal defect (VSD), and pulmonary regurgitation. Valvular heart diseases such as Mitral stenosis (1), mitral regurgitation (5), aortic regurgitation (2), and aortic stenosis (1) were found in 23% of patients. CT-Thorax was performed in post COVID patients prior to cardiac surgery to analyze the extent of lung involvement.[8]
Figure 1: Showing distribution of post-COVID status

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Majority of the lung computed tomography (CT) findings observed were minimal fibrotic changes, patchy ground-glass opacities, and features of atelectasis [Table 1]. 42.8% of patients showed only minimal fibrotic changes in CT Thorax. Twenty percent (7) post-COVID patients had normal CT thorax, 63% (22) showed CT score in between 1 and 5 followed by 11.42% (4) had CT score 6–10 and only 5.7 (2) % had scores between 11 and 15. A patient with CT score of 15 had prolonged ventilation time (72 h), ICU stay (9 days), inotropic support (10 days), and postoperative hospital stay of 21 days. He also needed minithoracotomy for clot evacuation.
Table 1: Characteristics of computed tomography - thorax

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COVID category and treatment details

Among the 35 patients, 54.3% (19) were under category A, 28.6% (10) under category B and 17.1% (6) of the patients were category C. Ten patients were under domiciliary treatment (Category A-9, Category B-1). Twenty-five patients were admitted at the hospital, among them 10 under category A, 9 under category B, and 6 under category C [Table 2]. Five patients needed ICU admission during the COVID period and none of them required ventilator support. About half of the patients had either pulmonary or cardiac complications during or following the COVID-19. Five of them had pneumonia, two had derangement of renal function, one had stroke, three had post COVID cardiac failure, and six patients had myocardial infarction. Patients who had post-COVID pneumonia were taken up for surgery with a minimum of 25 days followed by, 41,62, 69, and 120 days after became negative. Patients with post COVID left ventricular failure underwent cardiac surgeries 38, 67, 70 days after becoming COVID negative. Patients who had MI during or immediately following COVID-19, had Coronary artery bypass graft (CABG) after 17, 22, 38,50,64 and 138 days of COVID negative period. The mean period of duration of COVID positive period was 11 days (Minimum of 5 days and maximum of 19 days).
Table 2: Categorization of COVID patients (according to corona virus outbreak control and prevention state cell, Government of Kerala)

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Three patients under category C received either single or combination of antivirals; one received injection Remdesvir, another received Famipiravir, and one patient received a combination of Lopinavir and Ritonavir. One patient was treated with Hydroxychloroquine. Four patients treated with corticosteroids alone or in combination with bronchodilators or antibiotics. Most of them took Vitamin C and Zinc supplements. Subjects have median post COVID period of 61 days (interquartile range 32–109 days). The mean COVID antibody titer showed 158U/ml (minimum of 4.26 maximum of >250). PFT was performed in 10 patients and, three showed normal, five showed restrictive features and two patients showed both restrictive and obstructive pattern [Figure 2] and [Figure 3]. Due to the increased risk of acquiring COVID-19 from hospital surroundings, PFT was performed in small proportion of patients.
Figure 2: Showing FVC and FEV1

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Figure 3: Showing FEV1/FVC ratio

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Comparison of post COVID versus non-COVID patients

A total of 512 patients including 35 post-COVID and 477 non-COVID were included in the study. [Table 3] describes the baseline characteristics of the study cohort. Majority of the patients were male in both groups. The mean LVEF in post COVID patients is 50% and non COVID patients is 53%. Above half of the study groups was under NYHA I-II class followed by NYHA class III and class IV. The mean creatinine in post COVID patients was 1.27 mg/dl and non-COVID patient was 1.09 mg/dl (P-0.1174).
Table 3: Baseline characteristics

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CABG was performed in majority of patients (80%-post COVID and 76.56%-non-COVID).Seven post COVID (2-Aortic valve Replacement (AVR) and 5-Mitral valve replacement (MVR) and 72 non COVID patients underwent valve replacement surgery [Table 4]. In valvular surgeries, one post COVID and 24 non-COVID had CABG + Valve replacement surgery. Diverse cardiac surgeries were performed in post COVID patients, CABG was the most common surgery performed. Redo sternotomy was done in two post COVID patients with history of MVR and ASD closure. A total of 18 emergency CABG surgeries were performed during the study. Emergency CABG was performed in two post COVID patients with a post COVID period of 17 and 20 days. One patient had critical CAD, post COVID status of 20 days; referred to our hospital for high risk CABG with ventilator support and went into cardiac arrest twice. In addition, he had large bilateral pleural effusion. The emergency CABG was done with CPB support and shifted to ICU with Intra-aortic balloon pump (IABP). Postoperatively, he had multiple episodes of ventricular tachycardia treated conservatively and was discharged with stable cardiac status on 13th postoperative day. Another patient with a post COVID status of 17 days had complication while attempting PCI, LM, to LAD and needed emergency CABG. IABP was instituted in view of low LVEF and ischemic heart. He was discharged in clinically stable condition on 7th postoperative day.
Table 4: Types of surgery performed

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[Table 5] describes the intra operative details of both groups. Most of the cases were elective, 2 cases in post COVID patients were done on an emergency basis. 87% of the total cases were CABG (Including CABG ± AVR/MVR).Majority of the CABGs were performed on beating heart, only four patients had on pump CABG. Two post COVID patients needed on pump CABG; one patient had CABG with infected stent removal (LAD) and another patient had refractory AF with borderline hemodynamics after Left internal mammary artery (LIMA) harvesting. The requirement of IABP is also higher in post COVID patients. One patient presented with acute pulmonary edema needed IABP support and he had a post COVID status of 20 days. Two patients with severe LV dysfunction, one with EF of 27% and another with EF 35% with ischemic heart required IABP prior to induction. Another patient who had elevated PA pressures and borderline hemodynamic needed IABP after grafting. Another patient with biventricular dysfunction and borderline hemodynamic, elective IABP was inserted postoperatively. None of the patients with post COVID cardiac failure needed IABP.
Table 5: Intraoperative details

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Seven post-COVID and 72 non-COVID patients underwent valve replacement surgeries (Including Valve + CABG). The post COVID patients had a mean CPB time of 148 min and cross clamp time of 85 min. Tissue valves were commonly used in both groups. One post COVID patient underwent redo MVR, whereas six non-COVID patients underwent redo valve replacement including two redo MVR and four redo AVR (p-0.5992). Redo MVR had to be performed in a patient with infective endocarditis, within 11 days of becoming COVID negative. Complex procedures like total arterial revascularization (TAR) or endarterectomy was performed in 11 patients.

Postoperative outcomes in post COVID versus non COVID patients

[Table 6] represents the postoperative outcomes in post COVID and non COVID patients. The clinical outcomes of 35 post COVID patients were compared with 477 non COVID patients, who underwent cardiac surgery during the study. All patients were shifted to ICU after the surgery and ventilated. The mean ventilation time was 18.44 h in post COVID and 16.63 in non-COVID patients (P-0.4525). Two post COVID patients had late extubation, one with multiple cardiac arrest and needed ventilation prior to surgery, and another who underwent minithoracotomy for hemothorax. Most of the post COVID patients were in ICU for 2–3 days with a mean ICU stay of 2.38 and non COVID patients were in ICU for a mean period of 2.04. The mean postoperative hospital stay (days) 9.18 in post COVID and 7.83 in non-COVID patients (p-0.1847). Two post COVID patients needed prolonged postoperative hospital stay; one of them required antibiotic treatment for endocarditis and other needed hemodialysis. One patient with preoperative COVID had sudden right-sided hemothorax after surgery (AVR + VSD Closure + Pulmonary valve repair) and thoracotomy was done for clot evacuation. Another patient was re-intubated for postoperative hemodynamic instability. The pulmonary complication includes pneumonia and severe pleural effusion requiring intercostal drainage (ICD) or thoracocentesis. 8.57% of post COVID patients and 3.77% of non-COVID patients had pulmonary complications (p-0.1672). One post COVID patient needed ICD and two needed thoracocentesis. The occurrence of surgical site infection is similar in both groups. One post COVID patient with CKD on dialysis required prolonged hospital stay and developed sternal wound infection. 17.4% post COVID and 10% of non COVID patient had arrhythmia post operatively (P-0.1885). No postoperative mortality was reported in post COVID patients. Overall, no remarkable difference observed between post COVID and non COVID patients in terms of, ventilation time, length of ICU stay, postoperative hospital stay, duration of inotropic support, re-exploration, reintubation, and occurrence of arrhythmias, pulmonary complications, surgical site infection and mortality. The postoperative recovery and survival rate after cardiac surgery is almost similar in both groups.[6] One patient under category A and two under category B had pleural effusion one needed ICD and others needed thoracocentesis. Postoperative anticoagulation with low molecular weight heparin was continued until discharge for immediate post COVID patients to prevent thromboembolic complications.
Table 6: Comparison of postoperative outcomes

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Our patients were relatively hemodynamically stable after the surgery and no postoperative mortality was reported in post COVID patients. The postoperative mortality in non COVID patients at the same period of time was 0.419% (P-0.7015). Among 35 cases, 2 cases were done on an emergency basis. A patient who was a known case of congenital heart disease with restrictive perimembranous VSD, severe aortic regurgitation, and pulmonary regurgitation, with a recent history of Infective endocarditis, underwent VSD closure, AVR and pulmonary valve repair, IABP inserted in view of biventricular dysfunction and borderline hemodynamics. The patient had sudden right-sided hemothorax on 5th day and mini thoracotomy was done for clot evacuation and was discharged in a stable state on 20th postoperative day. One patient with post COVID status of 17 days; who had complication during PCI, transferred to CTVS for emergency CABG. The surgery was done with IABP support and was discharged on a stable condition. CABG and infected stent removal was performed in one patient, who had PCI to LAD in 2017 and in November 2020 (XIENCE Xpedition) due to complete total occlusion of the stent. Later he had fever probably due to the lack of aseptic condition during the angioplasty. He had COVID-19 in December last week and recovered after 10 days. Due to the recurrence of CAD, he was referred to our hospital for CABG. During the surgery, about 5–10 ml pus was removed.

  Discussion Top

The cardiac surgery during the COVID 19 pandemic is challenging and the choice to operate is based on patient's factors and disease severity. In our study, about 35 post COVID patients underwent diverse cardiac surgeries during the study. Their postoperative recovery and clinical outcomes were similar to non-COVID patients.

No significant difference observed between two cohorts, in terms of ventilation time, length of ICU stay, re-exploration, reintubation, duration of inotropic support, mortality, occurrence of arrhythmias, pulmonary complications, wound infection, and postoperative hospital stay. The postoperative clinical outcomes and survival rates in both groups were almost similar, indicating that the postoperative recovery of post COVID patients is similar to non-COVID patients without any added morbidity. Similarly, in a study conducted by Walter J et al., categorized study population into three categories, first group comprise of patients who underwent cardiac surgery >10 days after positive RT-PCR, 2nd group consist of patients with a positive RT-PCR within 10 days before or after surgery and group 3 consist patients who presented positive RT-PCR >10 days after surgery. The postoperative complications and death were significantly higher in groups 2 and 3 than in group 1, and no significant difference between groups 2 and 3 was seen. Although no significant differences were observed in ICU length of stay, total postoperative hospitalization time was significantly higher in group 3 than in groups 1 and 2.[10],[27]

Majority of the post COVID patients in our study had a post COVID status of less than 75 days. Only few post COVID patients underwent surgery during the immediate post COVID period, especially one patient who underwent redo MVR, 11 days after became COVID negative. Furthermore, their postoperative outcomes were similar to non-COVID patients, without any added morbidity and mortality. In contrast, many studies showed that cardiac surgery in active COVID patients is associated higher rate of morbidity and mortality. Delaying elective cardiac procedures in RT-PCR-positive patients may help reduce risks of perioperative complications and death.[10],[18],[19]

In our study, the occurrence of postoperative complications was similar to that of non-COVID patients. In contrary, few studies had shown that elective surgery 0–4 weeks after SARS-CoV-2 infection is associated with an increased risk of postoperative complications. Surgery performed 4–8 weeks after SARS-CoV-2 infection is still associated with an increased risk of postoperative pneumonia, whereas surgery 8 weeks after COVID-19 diagnosis is not associated with increased complications.[17]

Seven post-COVID underwent cardiac surgery within 30 days of COVID negative period, 6 of them were under category A and B and 3 of them were readmitted for pleural tapping. Only one patient under category C, developed multiple cardiac arrest and was taken up for emergency CABG and had VT during the postoperative period. A study of patients recently recovered from COVID 19 infection, CMR revealed cardiac involvement in 78% patients and ongoing myocardial inflammation in 60% of patients (independent of preexisting conditions, severity and overall course of the acute illness, and time from the original diagnosis). Which indicate the need for ongoing investigation of the long-term cardiovascular consequences of COVID-19.[11]

Postoperative pericardial effusion leading to cardiac tamponade is a known complication of cardiac surgery patients.[24] One of our post COVID patient with congenital heart disease, minithoracotomy was done for clot evacuation. Acute circulatory collapse is a life-threatening and high mortality complication of COVID-19. In our study, the requirement of IABP was higher in post COVID patients than control group. One patient with acute pulmonary edema and two with severe LV dysfunction required IABP support prior to induction. Another two patients; one with elevated PA pressures and borderline hemodynamic and other with biventricular dysfunction required elective IABP after surgery. However, none of the patients with post COVID cardiac failure needed IABP. The use of IABP is associated with low postoperative complications and mortality.[26]

COVID-19 impacts the cardiovascular system in both the short and long term.[9] Cardiovascular manifestations of COVID-19 include myocarditis, arrhythmias, acute coronary syndrome, venous thromboembolism, cardiomyopathy, and heart failure.[23] Post COVID-19 condition may be due to a persisting endothelial dysfunction. An endotheliopathy likely contributes to the pulmonary and cardiovascular manifestations of COVID-19.[15],[16] COVID19 induces a hypercoagulable state which places patients at an increased thrombophilic risk and has been shown to result in both venous and arterial thrombosis.[25] Hypercoagulability seen in COVID-19 is a consequence of the inflammatory response to severe infection as well as the direct effect of SARS-CoV-2 on the endothelium. Many studies suggest postoperative use of anticoagulants to prevent thromboembolic disorders.[12],[21],[22] Our post COVID patients received anticoagulants until discharge, and hence no complications related to the potential hypercoagulopathic state were reported.

No significant difference in ventilation time was observed between the post COVID and non COVID patients. Some studies showed that cardiac surgery during influenza season was an independent risk factor for development of ARDS; duration of mechanical ventilation was also significantly longer than in noninfluenza seasons.[13] Another important concern is risk of postoperative complications in newly recovered COVID-19 patients. Postoperative pulmonary complications occur in half of the patients with perioperative SARS-CoV-2 infection and are associated with high mortality.[17],[20],[28] The occurrence of pleural effusion was also similar in both groups. None of our post COVID patients under category C had any pulmonary complications after the surgery.

Many studies suggest postponing nonurgent cardiac procedures and promoting nonoperative treatment to delay the need for surgery in active COVID patients.[26] In our study, none of the post COVID patients had died post operatively and within 45 days of follow-up. A recent international multicenter cohort study of 1,128 COVID positive patients undergoing emergency (74%) and elective (26.1%) surgeries showed that pulmonary complications occurred in 51.2% of patients with a 30-day mortality of 38% (82% of all deaths were due to COVID-19 infection).[18],[19] The mortality rate in COVID patients undergoing surgery was high.[13] Studies shows that postoperative mortality rate in post COVID patients is less as compared to COVID in immediate postoperative patients.[24] None of our patients died or acquired COVID 19 postoperatively. All patients referred or admitted here for cardiac surgery underwent mandatory COVID testing at the time of admission.

Elective cases who became COVID positive were discharged to isolation ward or home and followed up telephonically, the plan was to defer the surgery for 1–2 months following a negative COVID test as per hospital protocol. According to the revised one, patients referred for urgent surgeries with COVID were isolated and treated in our hospital and taken up for surgery after 8 days of quarantine following a negative antigen test. Around 8 cases were deferred during this time period and they were taken up for surgery after a mean period of 23 days.

This is a retrospective and a single-center-based study and it has own inherent limitations. PFT was not performed in all patients due to the increased risk of acquiring COVID from the hospital surroundings and because of critical coronary lesions, hence some PFT data were missing. In this study, we have not included any cases done with a COVID positive status at time of surgery and hence we do not know how an ongoing positive patient responds to cardiac surgery.

  Conclusion Top

Cardiac surgery in post COVID patients is not associated with significant mortality and morbidity. The postoperative outcomes, complications and survival rates are almost similar in both post COVID patients and non COVID patients. Post COVID patients recover in a similar way as non COVID patients after cardiac surgery. We performed diverse cardiac surgeries in post COVID patients and there were no complications related to the potential hypercoagulopathic state due to COVID-19 infection.

Ethics committee approval

This study was conducted retrospectively from data obtained for clinical purposes. We notified to the institutional ethics committee and they informed that approval is not required for retrospective studies.

Informed consent

This is a retrospective study design based on hospital records, verbal consent was obtained either directly or through telephone.

Statement of human and animal right

There was no infringement of human or animal rights in this study.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

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  [Figure 1], [Figure 2], [Figure 3]

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]


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