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Surgical Revascularization With Cardiopulmonary Bypass on a Patient With Severe COVID-19

Olivier Montandrau1, Hannan Arana1, Franck Ehooman1

  • 1Institut Mutualiste Montsouris, Paris, France.

Seminars in Cardiothoracic and Vascular Anesthesia
|October 15, 2020
PubMed

Insights

This case study highlights a diabetic patient with COVID-19 who experienced heparin resistance during cardiac surgery. Effective management requires multidisciplinary collaboration and careful perioperative care, especially concerning ventilation and anticoagulation.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Anesthesiology

Background:

  • Coronavirus disease 2019 (COVID-19) can cause severe respiratory and prothrombotic complications.
  • Cardiac surgery with cardiopulmonary bypass (CPB) activates hemostasis and inflammation.
  • The interaction between COVID-19 and CPB in cardiac surgery is not well understood.

Observation:

  • A diabetic patient with COVID-19 and three-vessel disease required urgent surgical revascularization.
  • The patient exhibited significant heparin resistance during CPB.
  • This resistance complicated the management of anticoagulation during the procedure.

Findings:

  • COVID-19 may significantly alter the response to anticoagulation during CPB.
  • Heparin resistance in COVID-19 patients undergoing cardiac surgery is a critical concern.
  • Successful management necessitates a tailored approach to anticoagulation and ventilation.

Implications:

  • Emphasizes the need for multidisciplinary team (MDT) discussion for complex cases.
  • Highlights the importance of thorough preoperative assessment in COVID-19 patients.
  • Stresses the critical role of meticulous perioperative management, including anticoagulation and mechanical ventilation, for patient safety.

Keywords:
COVID-19cardiopulmonary bypasscoronary artery bypass graftinghemostasisheparin resistanceinflammation

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