• Giovanni A Chiariello, Piergiorgio Bruno, Natalia Pavone, Maria Calabrese, Serena D'Avino, Francesco Ferraro, Marialisa Nesta, Piero Farina, Federico Cammertoni, Annalisa Pasquini, Rocco A Montone, Luca Montini, and Massimo Massetti.
• Cardiovascular Sciences Department, Agostino Gemelli Foundation Polyclinic IRCCS, Rome, Italy; Catholic University of The Sacred Heart, Rome, Italy. Electronic address: gio.chiariello88@tiscali.it.
• J. Cardiothorac. Vasc. Anesth. 2022 Jul 1; 36 (7): 191919261919-1926.

ObjectivePrevious studies reported a poor outcome in patients with coronavirus 2019 (COVID-19) undergoing cardiac surgery. Complications most frequently described were respiratory failure, renal failure, and thromboembolic events. In their recent experience, the authors observed a very high incidence of bleeding complications. The purpose of the study was to investigate a possible significant correlation between perioperative COVID-19 infection and hemorrhagic complications compared to non-COVID-19 patients.DesignSingle-center, observational, retrospective, matched case-control (1:2) study involving patients who underwent open-heart cardiac surgery from February 2020 and March 2021 with positive perioperative diagnosis of COVID-19 infection, matched with patients without COVID-19 infection.SettingCardiac surgery unit and intensive care unit of a university tertiary center in a metropolitan area.ParticipantsIn the study period, 773 patients underwent cardiac surgery on cardiopulmonary bypass (CPB). Among them, 23 consecutive patients had perioperative diagnosis of COVID-19 infection (study group). These patients were compared with 46 corresponding controls (control group) that matched for age, sex, body mass index, and Society of Thoracic Surgeons score.InterventionsOpen-heart cardiac surgery on CPB.Measurements And Main ResultsIn the study group, 2 patients (9%) died in the intensive care unit from severe respiratory failure, shock, and multiple organ failure. In the study group, patients showed a significantly higher incidence of bleeding complications (48% v 2%, p = 0.0001) and cases of surgical reexploration for bleeding (35% v 2%, p = 0.0001), a higher incidence of severe postoperative thrombocytopenia (39% v 6%, p = 0.0007), and a higher need of blood components transfusions (74% v 30%, p = 0.0006). Chest tubes blood loss and surgical hemostasis time were markedly prolonged (p = 0.02 and p = 0.003, respectively).ConclusionsA worrisome increased risk of early and late bleeding complications in COVID-19 patients was observed, and it should be considered when assessing the operative risk. CPB-related inflammatory reaction could exacerbate the deleterious effect of COVID-19 on the coagulation system and likely deviate it toward a hemorrhagic pattern.Copyright © 2021 Elsevier Inc. All rights reserved.

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