Coronary artery bypass grafting in patients with coronary artery disease and COVID-19: search for an optimal strategy

Abstract

Extent of cardiac surgery aid has dropped significantly globally due to reallocation of health care resources due to COVID-19 pandemic.Aim. To evaluate the results of chosen management strategy for patients with coronary artery disease (CAD) and COVID-19 manifested in the early postoperative period after coronary artery bypass grafting.Material and methods. We present our experience of treating 19 patients with CAD and COVID-19 manifested in the early postoperative period after coronary artery bypass grafting. The main symptoms of COVID-19 in these patients were high-grade fever, severe general weakness, shortness of breath, and decreased blood oxygen saturation. Laboratory data showed significant increases in fibrinogen, C-reactive protein, ferritin, procalcitonin, and D-dimer levels. In all patients, according to the chest computed tomography, a picture of unilateral or bilateral multisegmental pneumonia in the form of ground-glass opacity areas was determined. The damaged lung area varied from 10% to 55%.Results. Patients were treated in accordance with the Russian guidelines, followed by transfer to continue therapy in specialized infectious diseases hospitals. Sixteen patients transferred to infectious diseases hospitals were subsequently discharged from in a satisfactory condition. Three patients died from various complications of COVID-19 (mortality rate, 16%).Conclusion. The development of new screening strategies, standard guidelines and protocols for the management of cardiac surgery patients in a pandemic will contribute to an earlier detection of COVID-19 and, accordingly, a timely change in treatment strategy.