Features of the course of coronavirus infection in patients after thoracic and cardiac surgery

Objective: To study the features of the coronavirus infection course in cardiosurgical and thoracic patients to determine the factors potentially affecting the possibility of lethal outcome. To identify the predictors of fatal outcome based on the analyses of the features of the coronavirus infection course in this category of patients.

Material and methods: During the analyzed period 80 patients from the departments of thoracic surgery and cardiac surgery were transferred to the infectious diseases department: 20 patients from the cardiac surgery department (CSD) – group 1; 60 patients from the thoracic surgery departments (TSD) – group 2. A control group number 3 consisting of 59 non-thoracic and non-cardiosurgical patients was also formed. According to the disease outcome the patients were divided into two groups: group 1 – fatal outcome, group 2 – recovery.

Results: Out of 80 patients, lethal outcome was recorded in 25 cases: 22 patients of the thoracic profile (36% of the total number of transferred from this department) and 3 patients of the cardiosurgical profile (15% of the total number of those transferred from the cardiac surgery department). 20 out of 20 cardiac patients had been operated on the day before, 49 out of 60 thoracic patients also underwent surgery. 3 people from the group of non-operated patients transferred from departments of thoracic surgery died. Moreover, after pneumonectomy, fatal outcome was recorded in 7 out of 8 cases (87.5%).

Conclusion: During the analyses of indicators it was revealed that the number of fatal outcomes in patients of the thoracic profile with COVID-19 infection is higher than of the cardiosurgical profile and in the infectious diseases department. Presumably, this is due to the fact that coronavirus infection affects the lungs to a greater extent, and in patients with a thoracic profile (in particular, those who have undergone resection interventions), the volume of the lung parenchyma is initially reduced. This is confirmed particularly by the highest percentage of fatal outcomes after pneumonectomy. Cardiosurgical patients after surgical interventions do not have a reduction in the functioning lung parenchyma, which creates an additional “reserve” for recovery. Moreover, men predominate among patients of the thoracic profile, with the survival rate lower in all groups compared to women. Patients transferred from thoracic departments showed higher rates of systemic inflammation, which indicates a more severe course of the viral infection and the possible development of complications.

When analyzing the predictors of lethal outcome, the following factors were identified: male gender and, in general, a more severe course of a viral infection (low saturation, a high percentage of lung lesions on CT, more pronounced changes in laboratory screening). The studied factors are associated with a large number of fatal outcomes in thoracic and cardiac surgery patients. Among the factors that do not affect the prognosis are diabetes mellitus, stroke and myocardial infarction in history.

Thus, patients diagnosed with coronavirus infection that developed after thoracic surgery had the most unfavorable prognosis. The revealed patterns are of interest for optimizing the routing of this category of patients in order to prevent coronavirus infection.

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