RESULTS
Four patients were found to be COVID-19 positive in the preoperative screening. As none of the patients posed a clinical emergency, the surgery was postponed until COVID-19 negative results were obtained.
All the patients were male, their mean age was 58.2 years (45 – 68 years) and all of them were admitted to our unit with urgent conditions (acute myocardial infarction, native valve infective endocarditis, rapidly expanding aortic aneurysm and infected previous ascending aortic graft with a communicating fistula to the sternal wound). (Table 1)
All patients were screened for COVID-19 as part of our previously described protocol on the first day of admission and the screening swabs were repeated after 5 days, and subsequently every 48 hours until the desired two negative tests were obtained, and the patients were listed for urgent surgery.
Two patients tested negative on the first repeated swab while the other two have four subsequent positive swabs before becoming negative. The mean delay to surgery was 17.5 days (5 – 31 days). (Table 1)
Two of the patients showed radiological changes in the non-contrasted CT chest, described as diffuse ground-glass opacities, predominantly on the lower lobes and suggestive of COVID-19 pneumonitis. These two patients were closely monitored with serial CXR showing resolution of the infiltrates in a week time. (Table 2)
None of the patients developed pyrexia (> 38o C) and only one patient was categorized as having COVID-19 symptoms, consistent on breathlessness, but this could also be attributed to his presentation with acute coronary syndrome and heart failure in addition to the suggested pneumonitis for COVID-19. (Table 2)
Blood test analysis revealed non-specific changes. The highest white blood cell count at presentation was normal (median 7.5 x 109 c/L, (5.6 - 28.3 x 109 c/L)) except for the patient presenting with acute coronary syndrome and heart failure. The lymphocyte count varied from 0.5 to 1.0 x 109 c/L and the LDH and CRP values were deemed unreliable due to the concomitant diagnosis of ongoing infection (endocarditis and aortic graft infection) or acute inflammatory events (acute coronary syndrome and expanding aneurysm). (Table 2)
All patients underwent surgery once tested negative for COVID-19, although PPE precautions were taken during the operation and postoperative period. The repeated swabs after surgery (taken between postoperative days 1-9) were negative for all patients.
None of the patients developed any respiratory complications related to COVID-19, and they were all extubated uneventfully on the same day of surgery or the following two days depending on the nature of the original operation. Mean mechanical ventilation times were 12.5 hours (6 – 24 hours) and the mean of stay in ITU was 3.5 days (3 – 4 days). (Table 3)
All the patients are alive and two of them have already been discharged home well (mean total hospital stay 24.5 days (18 – 31 days), mean postoperative hospital stay 7 days (5 – 9 days), while the other two remain in hospital to complete a six-week regime of intravenous antibiotics due to their original diagnosis. (Table 3)