Respiratory outcomes and predictors of respiratory failure development during surgical myocardial revascularisation in patients who underwent COVID-19

Objective. To study respiratory outcomes and identify predictors of respiratory failure development in patients undergoing surgical myocardial revascularization after COVID-19.

Material and methods. The study analyzed clinical data from 121 patients who underwent elective surgical myocardial revascularization from 2018 to 2022. The first group included 52 patients who had COVID-19 prior to surgery, on average 3.3 ± 2.3 months before the operation, while the second group consisted of 69 patients without a history of COVID-19. Indicators of mechanical ventilation and gas composition of arterial blood were studied during the intraoperative and early postoperative periods, the frequency of respiratory failure (RF) was assessed, and predictors of its development were identified.

Results. Patients who had COVID-19 showed significantly lower oxygenation index compared to those without the infection, both in the intraoperative period — 258 [184.6; 301] vs. 384.4 [335; 435] respectively (p = 0.0002), and in the early postoperative period — 228 [174.6; 303.5] vs. 407.5 [351.4; 462.5] respectively (p = 0.0019) during coronary artery bypass grafting on a beating heart. Patients with a history of COVID-19 developed RF 6.6 times more often — 23.1% vs. 4.3%; Odds Ratio (OR) 6.6; 95% Confidence Interval (CI) 1.76–24.82; p = 0.0038. Predictors of RF development included: severity of COVID-19 (p = 0.0016), lung involvement during COVID-19 (p = 0.0083), RF during COVID-19 (p = 0.0061), and duration of stay in the Intensive Care Unit (ICU) during COVID-19 (p = 0.0002). One (0.02%) fatal outcome was recorded the day after surgery in a patient with COVID-19 due to acute respiratory distress syndrome (ARDS).

Conclusions. Patients who have had COVID-19 exhibit respiratory impairments and a high risk of developing respiratory failure during surgical myocardial revascularization on a beating heart. Predictors of RF development are associated with the clinical course of COVID-19. Undiagnosed COVID-19 may contribute to the development of ARDS in the early postoperative period.

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