Impact of prior COVID-19 infection on cardiac surgery outcomes: optimal timing for valvular heart disease surgery

Abstract

The aim of this study was to evaluate the impact of prior COVID-19 infection on outcomes of surgery for valvular heart disease.

Materials and methods. The study included 200 patients with acquired valvular heart disease who underwent surgery at the National M. Amosov Institute of Cardiovascular Surgery affiliated to National Academy of Medical Sciences of Ukraine during 2021–2024. The cohort was divided into two groups: the first consisted of patients with a confirmed history of COVID-19 before surgery (n = 100), and the second included patients with no COVID-19 history, hospitalized in the pre-pandemic period (2016–2019). For the post-COVID-19 group, disease severity, the time interval from recovery to surgery, and the clinical phase (pre- or postoperative infection) were considered. Outcomes compared between groups included the rate of postoperative complications (respiratory, renal, and cardiac failure), duration of intensive care stay, myocardial functional status, total hospitalization time, and 30-day mortality. Statistical analysis was conducted using the Student’s t test, χ² test, and Mann-Whitney U test with a significance level of p < 0.05. The examination integrates a retrospective analysis of clinical outcomes in patients who had recovered from COVID-19 before undergoing surgery with a review of current scientific literature. The study focused on determining the optimal timing for cardiac surgery post-recovery and comparing postoperative complication rates, hospitalization and intensive care durations, myocardial function, and 30-day mortality based on COVID-19 history.

Results. Patients with a history of COVID-19 had a significantly higher 30-day postoperative mortality rate (20 % vs. 2 %, p < 0.01), a greater need for mechanical ventilation exceeding 24 hours (27 % vs. 9 %), and longer intensive care unit stays. A marked increase in the frequency of acute heart failure (13 % vs. 4 %) was observed, while acute kidney injury occurred exclusively in the post-COVID-19 group. Among patients who underwent surgery less than 6 weeks after COVID-19, complication rates reached 50 %, with mortality exceeding 30 %. The most favorable outcomes were observed when surgery was performed no earlier than 8–12 weeks post-recovery. Postoperative SARS-CoV-2 infection was associated with a 60 % mortality rate, representing the highest risk in the entire cohort.

Conclusions. Previous COVID-19 infection is an independent risk factor for adverse outcomes following cardiac surgery. Patients with post-COVID-19 status are more likely to develop respiratory, cardiac, and renal complications and have a significantly increased mortality risk. Elective surgery should be deferred for at least 8 weeks following COVID-19, with 12 weeks or more being optimal. Postoperative COVID-19 infection significantly worsens prognosis, highlighting the importance of perioperative prevention. These findings underscore the need for risk stratification and a multidisciplinary approach in preparing post-COVID-19 patients for cardiac surgery.