THE IMPACT OF PREOPERATIVE COVID-19 INFECTION ON EARLY POSTOPERATIVE RESULTS IN MITRAL VALVE REPLACEMENT

Аннотация

Objective: To evaluate the safety and outcomes of patients who underwent mitral valve replacement (MVR) after recent COVID-19 infection. Material and Methods. The study included the treatment results of 24 patients who were COVID-positive before undergoing MVR at the State Institution "RSSPMC named after academician V. Vakhidov" from June 2021 to July 2023. At the time of hospitalization, none of the patients exhibited symptoms of COVID-19. The average duration from a positive PCR test to surgery was 86.3 ± 14.7 days. The average age was 59.1±14.8 years, and the average ejection fraction was 46.4 ± 12.9%. Before surgery, 91.7% of patients were classified as NYHA class IV, and two patients as NYHA class III. The average EuroScore II was 4.6±0.7. Hypertension was present in 58.3%, half had type 2 diabetes, and one-third had chronic kidney disease. None required hospitalization or intubation due to COVID-19 infection. Preoperative pulmonary function testing was normal in 75% of patients, while 25% had restrictive pulmonary defects on spirometry. Results. A history of moderate or severe COVID-19 increased the risk of long-term pharmacological hemodynamic support by 3.62 times (95% CI 1.9-7.2; p=0.001). The mean cardiopulmonary bypass (CPB) time was 122 minutes, and the mean aortic occlusion time was 93 minutes. The mean time to extubation was 22±3.6 hours, and the mean ICU stay was 2 days. Postoperatively, five patients were extubated within 24 hours, three on postoperative day 1, and two on postoperative day 2. 25% required noninvasive ventilation post-extubation, and one was discharged on long-term oxygen therapy. All patients needed long-term inotropic support, with none requiring re-intubation. Respiratory failure occurred in 25%, and 25% required CPAP/BiPAP post-extubation. Two patients developed acute kidney injury (AKI), with renal function recovery by discharge. The average hospital stay post-surgery was 16 days. Conclusion. MVR can be safely performed in patients with mitral valve insufficiency and preoperative COVID-19 infection after a recovery period. A multidisciplinary team approach is beneficial in timing the operation in complex cases.