key: cord-0698073-2jpoxn5e
authors: Yandrapalli, Srikanth; Cooper, Howard A; Malekan, Ramin
title: Successful coronary artery bypass operation in a SARS‐COV‐2 infected patient with acute coronary syndrome
date: 2020-07-11
journal: J Card Surg
DOI: 10.1111/jocs.14784
sha: dd7d4c1ef0f0162046226d74a7e98afde01db35f
doc_id: 698073
cord_uid: 2jpoxn5e

The coronavirus disease 2019 (COVID‐19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) is overwhelming healthcare resources and infrastructure worldwide. Earlier reports have demonstrated complicated postoperative courses and high fatality rates in patients undergoing emergent cardiothoracic surgery who were diagnosed postoperatively with COVID‐19. These reports raise the possibility that active COVID‐19 might precipitate a catastrophic pathophysiological response to infection in the postoperative period and lead to unfavorable surgical outcomes. Hence, it is imperative to screen patients with SARS‐CoV‐2 infection before surgery and to carefully monitor them in the postoperative period to identify any signs of active COVID‐19. In this report, we present the successful outcome of coronary artery bypass grafting (CABG) operation in a patient with asymptomatic SARS‐CoV‐2 infection presenting with an acute coronary syndrome and requiring urgent surgical intervention. We employed a thorough strategy to identify subclinical COVID‐19 disease, and after confirming the absence of active disease, proceeded with the CABG operation. The patient outcome was successful with the absence of any overt COVID‐19 manifestations in the postoperative period.

We present a case of a successful CABG surgery in a patient with asymptomatic SARS-CoV-2 infection presenting with acute coronary syndrome and with multi-vessel severe CAD requiring urgent surgery.

We thoroughly evaluated the patient to identify active COVID-19 RNA has only 70% sensitivity. Any clinical change to suggest active COVID-19 in the preoperative or postoperative period should prompt repeat swab testing or chest CT imaging to improve risk stratification. Chest CT screening has a higher sensitivity (98%) than nasal swab for SARS-CoV-2 infection as CT findings occur earlier. 6 Post-intubation bronchoalveolar lavage can be considered.

As we move forward in this pandemic, we need to continue to provide appropriate medical care for patients with asymptomatic or subclinical SARS-COV-2 infection who require cardiac surgery.

Careful screening strategies, standard guideline recommendations and hospital level protocols are required to identify higher risk patients who are at greater risk of postsurgical morbidity and mortality.

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Acute type A aortic dissection during COVID-19 outbreak

Sensitivity of chest CT for COVID-19: comparison to RT-PCR

The authors declare that there are no conflict of interests.

Patient's right to anonymity and confidentiality is protected in this report.

http://orcid.org/0000-0001-6225-1137