Coronary Artery Bypass Graft During the COVID-19 Pandemic

Silveira, Lucas Molinari Veloso da; Guerreiro, Gustavo Pampolha; Lisboa, Luiz Augusto Ferreira; Mejía, Omar Asdrúbal Vilca; Dallan, Luís Alberto Oliveira; Jatene, Fábio Biscegli

doi:10.21470/1678-9741-2020-0283

Cited by 11 publications

(11 citation statements)

References 6 publications

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“…The COVID-19 is not supposed to disappear but remains among us as another endemic viral disease, also pending if immunity after the SARS-CoV-2 infection or a vaccine will lead to effective and lasting protection. For the cardiovascular surgeon, the decision of the appropriate surgical moment became even more sensitive in times of COVID-19 pandemic, where delays add significantly to the burden of the disease [ 24 ] .…”

Section: Discussionmentioning

confidence: 99%

COVID-19 in the Perioperative Period of Cardiovascular Surgery: the Brazilian Experience

Gomes¹,

Rocco²,

Pimentel³

et al. 2021

Braz J Cardiovasc Surg

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Introduction We investigated the clinical course and outcomes of patients submitted to cardiovascular surgery in Brazil and who had developed symptoms/signs of coronavirus disease 2019 (COVID-19) in the perioperative period. Methods A retrospective multicenter study including 104 patients who were allocated in three groups according to time of positive real time reverse transcriptase-polymerase chain reaction (RT-PCR) for the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2): group 1, patients who underwent cardiac surgery > 10 days after positive RT-PCR; group 2, patients with a positive RT-PCR within 10 days before or after surgery; group 3, patients who presented positive RT-PCR > 10 days after surgery. The primary outcome was mortality and secondary outcomes were postoperative complications, intensive care unit (ICU) length of stay, and postoperative days of hospitalization. Results The three groups were similar with respect to age, the European System of Cardiac Operative Risk Evaluation score, and comorbidities, except hypertension. 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. Group 2 showed a high prevalence of surgery performed as an urgent procedure. 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. Conclusion COVID-19 affecting the postoperative period of patients who underwent cardiovascular surgery is associated with a higher rate of morbidity and mortality. Delaying procedures in RT-PCR-positive patients may help reduce risks of perioperative complications and death.

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Section: Discussionmentioning

confidence: 99%

COVID-19 in the Perioperative Period of Cardiovascular Surgery: the Brazilian Experience

Gomes¹,

Rocco²,

Pimentel³

et al. 2021

Braz J Cardiovasc Surg

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“…9,10 It has been reported that patients who underwent cardiac surgery during 2020 have been infected with COVID-19, and that patients with CVD are more likely to have a severe presentation of SARS from COVID-19. 11 Another major concern is that patients with CVD disease are afraid to call emergency assistance or go to emergency rooms for fear of contracting COVID-19 or burdening an already-overwhelmed health-care system. 12 One possible explanation to the increase in death rate is that in most of the time only emergency surgeries were allowed, characterizing more severe patients.…”

Section: Discussionmentioning

confidence: 99%

Impact of the COVID‐19 pandemic on coronary artery bypass graft surgery in Brazil: A nationwide perspective

Khalil¹,

Vervoort

Roever³

et al. 2021

Journal of Cardiac Surgery

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Introduction The coronavirus disease 2019 (COVID‐19) pandemic has been a worldwide challenge, and efforts to “flatten the curve,” including restrictions imposed by policymakers and medical societies, have forced a reduction in the number of procedures performed in the Brazilian Health Care System. The aim of this study is to evaluate the outcomes of coronary artery bypass graft (CABG) from 2008 to 2020 in the SUS and to assess the impacts of the COVID‐19 pandemic in the number of procedures and death rate of CABG performed in 2020 through the database DATASUS. Methods This study is based on publicly available material obtained from DATASUS, the Brazilian Ministry of Health's data processing system, on numbers of surgical procedures and death rates. Only isolated CABG procedures were included in our study. We used the TabNet software from the DATASUS website to generate reports. Results We identified 281,760 CABG procedures performed from January 2008 to December 2020. The average number of procedures until the end of 2019 was of 22,104. During 2020 there was a 25% reduction CABG procedures, to 16,501. There was an increase in the national death rate caused by a statistical significant increase in death rates in Brazil's Southeast and Central‐west regions. Conclusion The COVID‐19 pandemic remains a global challenge for Brazil's health care system. During the year of 2020 there was a reduction in access to CABG related to an increase in the number of COVID‐19 cases. There was also an increase in the national CABG death rate.

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“…Combining this with the predilection of SARS-CoV-2 to cause microvascular pathology suggests that free-flap reconstructions may face unique challenges with concurrent SARS-CoV-2 infection. Several case studies have described remarkable surgical site complications in the setting of SARS-CoV-2 infection [13][14][15]. Benmoussa et al described the failure of a chimeric thoracodorsal artery perforator flap and a free fibula flap performed for gingival mandibular squamous cell carcinoma, and da Silveira et al describe significant sternal dehiscence following a coronary artery bypass graft [14][15].…”

Section: Discussionmentioning

confidence: 99%

Two Cases of Impaired Wound Healing Among Patients With Major Head and Neck Free-Flap Reconstruction in the Setting of COVID-19 Infection

Inouye¹,

Zhou²,

Clark³

et al. 2021

Cureus

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Due to the microvascular effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), head and neck reconstructive surgeries utilizing free tissue transfers may be profoundly affected by SARS-CoV-2 infection in the immediate postoperative period. Our objective is to describe two adult patients who developed SARS-CoV-2 after undergoing relatively uncomplicated segmental mandibulectomies. In both cases, the patients were initially negative for SARS-CoV-2, underwent relatively uncomplicated segmental mandibulectomies with fibula free flap reconstructions, and were later discharged in stable conditions. Both patients subsequently experienced significant infectious sequelae at the donor and recipient sites with neartotal split-thickness skin graft loss in the donor sites in the setting of postoperative SARS-CoV-2 infection. The first patient developed sepsis and gangrenous changes to his fibula donor site requiring four operative debridements and partial amputation with subsequent osteomyelitis of the remaining fibula. The second patient experienced dehiscence of the oral fibula free flap as well as a 22 cm phlegmon at the fibula donor site that required surgical debridement. In consideration of these cases, SARS-CoV-2 infection during the immediate postoperative period of head and neck reconstruction procedures may elevate the risk of major wound complications. Special consideration must be taken when performing free tissue transfers during the COVID-19 pandemic.

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Coronary Artery Bypass Graft During the COVID-19 Pandemic

Cited by 11 publications

References 6 publications

COVID-19 in the Perioperative Period of Cardiovascular Surgery: the Brazilian Experience

COVID-19 in the Perioperative Period of Cardiovascular Surgery: the Brazilian Experience

Impact of the COVID‐19 pandemic on coronary artery bypass graft surgery in Brazil: A nationwide perspective

Two Cases of Impaired Wound Healing Among Patients With Major Head and Neck Free-Flap Reconstruction in the Setting of COVID-19 Infection

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