Analysis of the influence of COVID-19 infection on the early clinical efficacy of patients undergoing single valve replacement surgery: A retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XU Liu , HUO Yongfeng , TIAN Lijun , ZHU Yun , XIAO Juan ,  MA Ruiyan

The Second Affiliated Hospital of Chinese People's Liberation Army Medical University, Chongqing, 400000, P. R. China;

Corresponding author：

MA Ruiyan, Email: 762602072@qq.com

Keywords：

Cardiopulmonary bypass; valve replacement; COVID-19

DOI：

10.7507/1007-4848.202308043

Video：

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Objective To investigate the impact of COVID-19 infection on the early clinical outcomes of patients undergoing valve replacement. Methods Perioperative data of patients who underwent single valve replacement at the Second Affiliated Hospital of Chinese People's Liberation Army Medical University from January to February 2023 were consecutively collected. Based on COVID-19 infection status, patients were divided into a COVID-19 group and a non-COVID-19 group. General characteristics, comorbidities, operative time, aortic cross-clamp time, postoperative mechanical ventilation duration, ICU stay, myocardial enzyme profiles, and respiratory-related complications were compared between the two groups. The primary endpoint was the incidence of postoperative respiratory and circulatory complications, and the secondary endpoint was the postoperative myocardial enzyme profiles. Results A total of 136 patients were included, comprising 53 males and 83 females, with a mean age of (53.4±10.2) years. There were 32 aortic valve replacements, 102 mitral valve replacements, and 2 tricuspid valve replacements. No statistical difference was observed in the incidence of postoperative complications between the two groups [9.09% (6/66) vs. 11.43% (8/70), P=0.654]. However, the COVID-19 group had longer postoperative mechanical ventilation duration [1 201.00 (1 003.75, 1 347.75) min vs. 913.50 (465.50, 1 251.00) min, P=0.001] and ICU stay [3 (2, 3) days vs. 2 (2, 3) days, P<0.001] compared to the non-COVID-19 group. Additionally, troponin I [4.76 (2.55, 7.93) ng/mL vs. 2.66 (1.19, 5.65) ng/mL, P=0.001] and B-typenatriuretic peptide [608.50 (249.75, 1 150.00) pg/mL vs. 192.00 (100.93, 314.75) pg/mL, P<0.001] levels were significantly higher in the COVID-19 group. Conclusion For patients with single valve disease undergoing elective surgery, short-term outcomes after recovery from COVID-19 infection are favorable, with no significant increase in in-hospital mortality or postoperative complication rates.

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1. Puntmann VO, Carerj ML, Wieters I, et al. Outcomes of cardiovascular magnetic resonance imaging in patients recently recovered from coronavirus disease 2019 (COVID-19). JAMA Cardiol, 2020, 5(11): 1265-1273.
2. Mohamed Abdel Shafi A, Hewage S, Harky A. The impact of COVID-19 on the provision of cardiac surgical services. J Card Surg, 2020, 35(6): 1295-1297.
3. 刘炫, 康盼, 江霞等. 新型冠状病毒肺炎常态化疫情防控期间胸心外科住院患者心理状态研究. 现代医药卫生, 2021, 37(21): 3688-3690.Liu X, Kang P, Jiang X, et al. Psychological status of thoracic and cardiovascular surgery inpatients during normalized COVID-19 prevention and control. J Mod Med Health, 2021, 37(21): 3688-3690.
4. 中华人民共和国国家卫生健康委员会. 新型冠状病毒感染诊疗方案(试行第十版). 中华临床感染病杂志, 2023, 16(1): 1-9.National Health Commission of the People’s Republic of China. Diagnosis and treatment plan for COVID-19 (trial version 10). Chin J Clin Infect Dis, 2023, 16(1): 1-9.
5. 孟庆义, 李玉柱. 解析新型冠状病毒肺炎肌钙蛋白升高现象. 中国急救医学, 2020, 40(3): 218-221.Meng QY, Li YZ. Discussion on the construction and management of the novel coronavirus ward. Chin J Crit Care, 2020, 40(3): 218-221.
6. Gunaydin S, Stammers AH. Perioperative management of COVID-19 patients undergoing cardiac surgery with cardiopulmonary bypass. Perfusion, 2020, 35(6): 465-473.
7. Shi S, Qin M, Shen B, et al. Association of cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan, China. JAMA Cardiol, 2020, 5(7): 802-810.
8. WHO Coronavirus (COVID-19) Dashboard. WHO Coronavirus (COVID-19) Dashboard with vaccination data.
9. 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.
10. Zhao YM, Shang YM, Song WB, et al. Follow-up study of the pulmonary function and related physiological characteristics of COVID-19 survivors three months after recovery. EClinicalMedicine, 2020, 25: 100463.
11. El-Boghdadly K, Cook TM, Goodacre T, et al. SARS-CoV-2 infection, COVID-19 and timing of elective surgery: A multidisciplinary consensus statement on behalf of the Association of Anaesthetists, the Centre for Peri-operative Care, the Federation of Surgical Specialty Associations, the Royal College of Anaesthetists and the Royal College of Surgeons of England. Anaesthesia, 2021, 76(7): 940-946.
12. Rohatgi N, Smilowitz NR, Reejhsinghani R. Perioperative cardiovascular considerations prior to elective noncardiac surgery in patients with a history of COVID-19. JAMA Surg, 2022, 157(3): 187-188.
13. 廖春晓, 王波, 吕筠, 等. 新型冠状病毒Omicron变异株病原学及流行病学研究进展. 中华流行病学杂志, 2022, 43(11): 1691-1698.Liao CX, Wang B, Lü J, et al. Progress in research of etiology and epidemiology of 2019-nCoV Omicron variant. Chin J Epidemiol, 2022, 43(11): 1691-1698.
14. 夏锋, 陈孝平. 新冠病毒感染对外科择期手术的影响. 临床外科杂志, 2023, 31(2): 190-194.Xia F, Chen XP. Impact of novel COVID-19 on elective surgical procedures. J Clin Surg, 2023, 31(2): 190-194.
15. 郭浩. 体外循环下心脏术后小剂量甘露醇缓慢应用临床疗效及安全性的研究. 新乡医学院, 2022.Guo H, Clinical efficacy and safety of slow application of low-dose mannitol after cardiac surgery under cardiopulmonary bypass, Xinxiang Medical University, 2022.
16. Li B, Yang J, Zhao F, et al. Prevalence and impact of cardiovascular metabolic diseases on COVID-19 in China. Clin Res Cardiol, 2020, 109(5): 531-538.
17. Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA, 2020, 323(11): 1061-1069.
18. 师艳菲, 李佩远, 黄达, 等. 血清LDH与CK-MB水平对不同类型COVID-19患者心肌损伤状况的Meta分析. 第十二届全国体育科学大会论文摘要汇编—墙报交流 (运动医学分会), 2022: 353-354.Shi YF, Li PY, Huang D, et al. Meta-analysis of serum LDH and CK-MB levels on myocardial injury in different types of COVID-19 patients. Abstracts of the 12th National Sports Science Congress: Poster Exchange (Sports Medicine Branch), 2022: 353-354.
19. El-Boghdadly K, Cook TM, Goodacre T, et al. Timing of elective surgery and risk assessment after SARS-CoV-2 infection: An update: A multidisciplinary consensus statement on behalf of the Association of Anaesthetists, Centre for Perioperative Care, Federation of Surgical Specialty Associations, Royal College of Anaesthetists, Royal College of Surgeons of England. Anaesthesia, 2022, 77(5): 580-587.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Latest ArticlesAnalysis of the influence of COVID-19 infection on the early clinical efficacy of patients undergoing single valve replacement surgery: A retrospective cohort study

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