Our Summary

This research paper talks about a case where a patient with COVID-19 and diabetes, who had a heart condition requiring surgery, showed unexpected resistance to a common blood thinner (heparin) during a procedure involving a heart-lung machine (cardiopulmonary bypass). The authors highlight that COVID-19 can cause severe breathing difficulties due to an extreme immune response and can also make blood more likely to clot. Both of these factors can complicate heart surgeries. They emphasize the importance of team discussions before surgery, detailed pre-surgery assessments, and careful management during and after surgery, especially in relation to mechanical ventilation and blood thinning. This case provides new insights into how COVID-19 might affect heart surgeries.

FAQs

  1. How can COVID-19 complications interfere with heart surgeries?
  2. Why did the patient with COVID-19 show resistance to the blood thinner heparin during a cardiopulmonary bypass?
  3. What precautions are suggested by the authors before, during, and after heart surgeries for patients with COVID-19?

Doctor’s Tip

A doctor might tell a patient undergoing heart bypass surgery to follow a healthy lifestyle after the procedure, including maintaining a balanced diet, exercising regularly, quitting smoking, and managing stress. These lifestyle changes can help improve the long-term success of the surgery and reduce the risk of future heart complications.

Suitable For

Patients who are typically recommended for heart bypass surgery include those with severe coronary artery disease, which is a condition where the blood vessels supplying the heart muscle become narrowed or blocked due to a buildup of plaque. These patients may experience symptoms such as chest pain (angina) or shortness of breath, and may have already undergone other treatments such as medication or angioplasty.

Other factors that may indicate the need for heart bypass surgery include:

  • Multiple blockages in the coronary arteries
  • Left main coronary artery disease
  • Diabetes
  • Previous heart attack
  • Weakened heart muscle (heart failure)
  • Other medical conditions that increase the risk of complications from coronary artery disease, such as kidney disease or peripheral artery disease

Each patient is evaluated individually by a team of healthcare providers, including cardiologists, cardiac surgeons, and other specialists, to determine the most appropriate treatment plan. The decision to recommend heart bypass surgery is based on a variety of factors, including the severity of the coronary artery disease, the patient’s overall health and medical history, and the potential risks and benefits of the procedure.

Timeline

  • Before heart bypass surgery:
  1. Patient is diagnosed with a heart condition that cannot be treated with medication or other less invasive methods.
  2. Cardiologist recommends heart bypass surgery as the best treatment option.
  3. Patient undergoes pre-operative assessments, including blood tests, electrocardiogram, and imaging tests to evaluate the extent of blockages in the coronary arteries.
  4. Patient is counseled on the risks and benefits of the surgery, and informed consent is obtained.
  5. Patient may need to make lifestyle changes, such as quitting smoking or losing weight, to improve the success of the surgery.
  • During heart bypass surgery:
  1. Patient is placed under general anesthesia.
  2. Surgeon makes an incision in the chest to access the heart.
  3. Heart-lung machine is connected to the patient to pump blood and oxygenate it during the surgery.
  4. Surgeon bypasses the blocked arteries by grafting blood vessels from other parts of the body.
  5. Surgery typically takes several hours to complete.
  • After heart bypass surgery:
  1. Patient is transferred to the intensive care unit (ICU) for monitoring and recovery.
  2. Patient may need to stay in the hospital for several days to a week, depending on their recovery progress.
  3. Patient undergoes physical therapy and cardiac rehabilitation to regain strength and mobility.
  4. Patient is prescribed medications to manage pain, prevent infection, and reduce the risk of blood clots.
  5. Patient is instructed on post-operative care, such as wound care, diet and exercise recommendations, and follow-up appointments with their healthcare provider.

Overall, the timeline of a patient’s experience before and after heart bypass surgery involves thorough pre-operative assessments, a complex surgical procedure, and a period of recovery and rehabilitation to improve heart function and overall health.

What to Ask Your Doctor

  1. What is the reason for recommending a heart bypass surgery?
  2. What are the potential risks and complications associated with the procedure?
  3. How experienced is the surgical team in performing heart bypass surgeries?
  4. Will I need to undergo any additional tests or procedures before the surgery?
  5. What is the expected recovery time and what follow-up care will be needed?
  6. How will my diabetes and COVID-19 status affect the surgery and recovery process?
  7. What measures will be taken to prevent complications related to COVID-19 during the surgery?
  8. How will my blood thinning medication be managed during and after the surgery?
  9. Will I need any special care or monitoring post-surgery due to my medical conditions?
  10. Are there any lifestyle changes or medications I should consider after the surgery to improve my heart health?

Reference

Authors: Montandrau O, Arana H, Ehooman F, Bouattour K, Cherruault M, Ouechani W, Hamdaoui I, Dufour G, Kattou F, Philip I, Beaussier M. Journal: Semin Cardiothorac Vasc Anesth. 2021 Mar;25(1):46-50. doi: 10.1177/1089253220966515. Epub 2020 Oct 15. PMID: 33054611