key: cord-0858866-cpn9kp56
authors: Ramzy, Danny
title: Commentary: COVID-19 in Cardiac Surgery – We are Still Learning and Have Yet to See All Possible COVID-19 Complications
date: 2020-10-15
journal: JTCVS Tech
DOI: 10.1016/j.xjtc.2020.10.007
sha: 5837f9b9d92f2575bb6c26c60cbcc2bbadba89a0
doc_id: 858866
cord_uid: cpn9kp56

nan

The novel coronavirus outbreak in Wuhan, China, led to over 31 million infected and nearly a million deaths 1, 2 . Coronavirus Disease 2019 (COVID 19) , is characterized by extreme virulence and a complex spectrum of pathologies ranging in severity from mild to multi-organ failure 3 and death. Over the past nine months, our knowledge of the pathophysiology and extrapulmonary manifestations of COVID-19 has grown tremendously. Yet, despite this, we are constantly discovering new manifestations such as the development of a hypercoagulable state 4-6 .

With an anxious global community focused upon the development of a novel vaccine, it's easy to overlook that unique and potentially fatal complications are yet to be identified.

In the current issue of "Journal of Thoracic and Cardiovascular Surgery TECHNIQUES," Manghat 7 and his team provide a single case-report describing a newly discovered, potential life- This case also highlights that the hypercoagulability associated with the COVID-19 infection may extend far beyond VTE and extend into arterial or implantable prostheses thromboses. Our surgical community is rapidly realizing that the extrapulmonary manifestations of COVID-19

infection have yet to be fully elucidated, especially in the post cardiac surgery patients.

Anticoagulation therapy falls into standard guidelines, with heparin followed by coumadin for thrombosed prosthetic valve. A new question now arises: should we treat all COVID positive cardiac surgical patient with coumadin? While such a sweeping strategy might seem overreaching, this reader suggests this treatment prudent if we focus upon prosthetic valve patients, where a tendency towards such complications has already been historically established.

The Manghat team case-report is another in a series of revelations highlighting the rapid evolution of our knowledge of COVID-19, and reminding us that we still have a great deal more to learn about this landmark disease. While no anticoagulation therapy post tissue valve implantation works in a majority of cases, it may not be appropriate in COVID-19 patients.

A Novel Coronavirus from Patients with Pneumonia in China

The outbreak of COVID-19: An overview

COVID-19 Illness in Native and Immunosuppressed States: A Clinical-Therapeutic Staging Proposal

COVID-19 coagulopathy: an evolving story

COVID-19 and its implications for thrombosis and anticoagulation

Thrombotic and haemorrhagic complications in critically ill patients with COVID-19: a multicentre observational study. Crit Care

Acute Post-operative Thrombosis of an Aortic Valve Prosthesis and Embolic Myocardial Infarction in a COVID-positive patient -An Unrecognised Complication