Case Report: Emergency CABG Following Failure of PTCA in a COVID-19 Patient
Silvia Romiti1, Marco Totaro1, Amalia Laderchi2
1Department of Clinical, Internal Medicine, Anaesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy.
Insights
This case report details a successful emergency coronary artery bypass grafting (CABG) in a COVID-19 patient. It highlights the management of cardiac surgery during the pandemic when guidelines are lacking.
Area of Science:
- Cardiology
- Infectious Diseases
- Cardiovascular Surgery
Background:
- The COVID-19 pandemic poses risks for patients undergoing cardiac surgery.
- Cardiopulmonary bypass (CPB) and SARS-CoV-2 infection share mechanisms like cytokine storms and hemostatic issues.
- Standard protocols for managing pre-operative COVID-19 patients needing urgent cardiac surgery are absent.
Observation:
- A patient presented with unstable angina and coronary artery dissection requiring urgent intervention.
- The patient had a confirmed severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection.
- Emergency coronary artery bypass grafting (CABG) was performed using cardiopulmonary bypass (CPB).
Findings:
- The emergency CABG surgery in the COVID-19 positive patient was successful.
- This case demonstrates the feasibility of performing complex cardiac surgery in infected patients.
- Effective management strategies can mitigate risks associated with combined SARS-CoV-2 and CPB.
Implications:
- This case provides valuable insights into managing non-deferrable cardiac surgeries during the COVID-19 pandemic.
- It suggests that with careful planning, cardiac surgery can be safely performed in COVID-19 patients.
- Further research is needed to establish evidence-based guidelines for this patient population.
Abstract:
The coronavirus disease 2019 (COVID-19) pandemic outbreak, caused by severe acute respiratory syndrome coronavirus-2 (SARS-Cov-2) is affecting people worldwide representing a public health emergency. The effect of concomitant COVID-19 on patients who underwent cardiac surgery using cardiopulmonary bypass (CPB) is still undefined. Both SARS-Cov-2 infection and CPB can develop a cytokines storm and haemostatic disarrangements leading to acute respiratory distress syndrome (ARDS) and post-perfusion lung syndrome, respectively. SARS-Cov-2 infection may trigger and exacerbate post-inflammatory state after CPB resulting in higher risk of post-surgical adverse outcomes. International guidelines lack to provide standard management protocols for pre-operative COVID-19 patients requiring non-deferrable cardiac surgery intervention. We present a report of a successful coronary artery bypass grafting (CABG) emergency operation in a COVID-19 patient, who presented unstable angina and coronary artery dissection during cardiac catheterization and percutaneous transluminal coronary angioplasty (PTCA).
Related Concept Videos
01:27Coronary Artery Disease V: Interprofessional Care
01:30Acute Coronary Syndrome I: Introduction
01:28Acute Coronary Syndrome IV: Interprofessional Care