Commentary: The silver lining of coronary artery bypass grafting in the era of coronavirus disease 2019

Abstract

Central MessageShort-term post-CABG outcomes appear to be relatively unchanged during the COVID-19 pandemic. However, volume has decreased significantly, and the longer-term influence of delayed care is yet to be seen.See Article page 132. Short-term post-CABG outcomes appear to be relatively unchanged during the COVID-19 pandemic. However, volume has decreased significantly, and the longer-term influence of delayed care is yet to be seen. See Article page 132. The global coronavirus disease 2019 (COVID-19) pandemic has caused significant disruption of health care services. Cardiac surgery, a specialty heavily dependent on intensive care resources, has been especially influenced due to reallocations of these resources, including ventilators as well as intensive care beds and staff.1Mohamed Abdel Shafi A. Hewage S. Harky A. The impact of COVID-19 on the provision of cardiac surgical services.J Card Surg. 2020; 35: 1295-1297Crossref PubMed Scopus (34) Google Scholar Parcha and colleagues2Parcha V. Kalra R. Glenn A.M. Davies J.E. Kuranz S. Arora G. et al.Coronary artery bypass graft surgery outcomes in the United States: impact of coronavirus disease 2019 (COVID-19) pandemic.J Thorac Cardiovas Surg Open. 2021; 6: 132-143Scopus (5) Google Scholar examine the risk of adverse outcomes among patients undergoing coronary artery bypass graft (CABG) surgery during the initial 9-month period of the COVID-19 pandemic. This retrospective cross-sectional analysis compared clinical outcomes of patients undergoing CABG from 26 health care organizations during pre-COVID-19 and COVID-19 study periods. The primary end point evaluated was mortality within 30 days. Secondary end points included stroke, acute kidney injury, acute respiratory distress syndrome, and prolonged mechanical ventilation. During the 2020 COVID-19 study period, there was a 36% decline in CABG case volume. Propensity-score matching of 3569 patient pairs revealed similar odds of mortality by 30 days. The odds of secondary outcomes in the matched pairs were also similar. The investigators concluded that whereas CABG volume declined during the pandemic, CABG procedures have been performed safely, despite the resource limitations encountered during the pandemic. The authors are to be congratulated for a well-written article. Due to limitations of the data available in the TriNetX database, a more granular analysis was not feasible, including evaluation of preoperative risk assessment as well as geographic differences. Nonrespiratory complications of COVID-19, such as thrombotic events, were not queried, which may be due to the low number of patients in the cohort identified as having COVID-19. Although the finding that CABG volume decreased during the COVID-19 pandemic is well-supported with other observational studies,3Salenger R. Etchill E.W. Ad N. Matthew T. Alejo D. Whitman G. et al.The surge after the surge: cardiac surgery post-COVID-19.Ann Thorac Surg. 2020; 110: 2020-2025Abstract Full Text Full Text PDF PubMed Scopus (60) Google Scholar,4Nguyen T.C. Thourani V.H. Nissen A.P. Habib R. Dearani J.A. Crestanello J.A. et al.The effect of COVID-19 on adult cardiac surgery in the United States: analysis of the Society of Thoracic Surgeons Adult Cardiac Surgery Database. Presented at the 57th Annual Meeting of the Society of Thoracic Surgeons.January 29, 2021Google Scholar the findings that postoperative outcomes are unchanged are in contrast to a larger study (n = 717,103) evaluating data from the Society of Thoracic Surgeons Adult Cardiac Surgery Database,3Salenger R. Etchill E.W. Ad N. Matthew T. Alejo D. Whitman G. et al.The surge after the surge: cardiac surgery post-COVID-19.Ann Thorac Surg. 2020; 110: 2020-2025Abstract Full Text Full Text PDF PubMed Scopus (60) Google Scholar which demonstrated an increased observed-to-expected mortality rate during the pandemic. Further studies evaluating the longitudinal effects of the ongoing COVID-19 pandemic are needed. We likely have not yet seen the broader influence of delayed and postponed cases. Coronary artery bypass graft surgery outcomes in the United States: Impact of the coronavirus disease 2019 (COVID-19) pandemicJTCVS OpenVol. 6PreviewThere has been a substantial decline in patients presenting for emergent and routine cardiovascular care in the United States after the onset of the coronavirus disease 2019 (COVID-19) pandemic. We sought to assess the risk of adverse clinical outcomes among patients undergoing coronary artery bypass graft (CABG) surgery during the 2020 COVID-19 pandemic period and compare the risks with those undergoing CABG before the pandemic in the year 2019. Full-Text PDF Open Access