key: cord-308702-90a4dj76
authors: Hussain, Azhar; Khan, Habib; Lopez‐Marco, Ana; Roberts, Neil; Oo, Aung
title: Cardiac surgery in patients with confirmed COVID‐19 infection: Early experience
date: 2020-06-12
journal: J Card Surg
DOI: 10.1111/jocs.14657
sha: 
doc_id: 308702
cord_uid: 90a4dj76

The novel coronavirus, now termed SARS‐CoV‐2, has caused a significant global impact in the space of 4 months. Almost all elective cardiac surgical operations have been postponed in order to reduce transmission and to allocate resources adequately. Urgent and emergency cardiac surgery is still taking place during the pandemic. The decision to operate in urgent patients with active/recent COVID‐19 infection is difficult to make, particularly as it is still an unknown disease entity in the setting of emergent cardiac surgery. We present a case series of three patients who underwent urgent cardiac surgery and who have had recent or active COVID‐19 infection.

The novel coronavirus, now termed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has caused a significant global impact on the economy, politics, and health in the space of 4 months.

Almost all elective cardiac surgical operations have been postponed with only urgent and emergency operations being performed globally. The prevalence of coronavirus disease-2019 (COVID-19) in patients with underlying cardiovascular disease is under-reported with evidence that preexisting cardiac disease can render patients more vulnerable to the disease process. 1 The decision to operate in urgent patients with active/recent COVID-19 infection is difficult to make as it is an unknown disease entity with outcomes of emergent cardiac surgery difficult to predict. We present a case series of three patients who underwent urgent cardiac surgery who have had recent or active COVID-19 infection.

A 44-year-old gentleman presented to hospital with worsening shortness of breath and presyncope on minimal exertion. Clinical examination suggested aortic stenosis and past medical history was significant for type 

A 68-year-old gentleman presented to hospital with fevers, lethargy, and recent onset back pain. Clinical examination revealed a diastolic murmur and he was febrile. His past medical history was significant for prostate cancer and type-2 diabetes mellitus. Blood cultures revealed Enterococcus faecalis and he was started on empirical intravenous antibiotics (gentamicin and co-amoxicillin). Magnetic resonance imaging spine was suspicious for discitis at C5-C6. Transthoracic echocardiogram was unable to 

A 60-year-old gentleman presented with an out of hospital cardiac arrest. Bystander cardiopulmonary resuscitation was given by his wife, followed by shocks administered by the ambulance crew, with a downtime of 10 minutes. His medical history was significant for hy- Our third case highlights the importance of a CT thorax as part of our routine preoperative cardiac surgical workup during this pandemic. Recent studies have suggested that CT changes may even precede RT-PCR findings and clinical signs of COVID-19. 4 Extensive patchy consolidation and ground-glass changes suggestive of COVID-19, warranted an extended period of observation in hospital in this case. Although this patient did not require significant respiratory support, it was important that his respiratory reserve was optimized before urgent surgery. Serial chest X-ray's showed a remarkable improvement in this case before being listed for surgery.

Our cases highlight the difficult decision making process in unprecedented times. The role of cardiac surgery in the presence of COVID-19 is still yet to be determined and long terms outcomes are clearly warranted.

All the authors declare that there no conflict of interests.

Local IRB guidance was followed. All patients were consented.

http://orcid.org/0000-0003-3941-4553

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