Higher incidence of heart failure and atrial fibrillation in valvular heart disease post-COVID-19

Abstract Funding Acknowledgements Type of funding sources: None. Patients with cardiovascular diseases are at higher risk of Coronavirus disease 2019 (COVID-19) complications. The data if post-COVID-19 patients are more susceptible to postoperative cardiac surgery complications are scarce. There are limited pieces of information on the possible consequences for patients with severe valvular disease undergoing valvular cardiac surgery. The study aimed to assess the impact of COVID-19 on patients with severe valvular disease and its postoperative course and outcomes. Methods We retrospectively identified 34 severe valvular disease patients indicated for surgery that underwent cardiac valvular surgery post-COVID-19. Adverse cardiovascular events in post-COVID-19 (heart failure (HF) and paroxysmal atrial fibrillation (AF) were recorded. All patients underwent control echocardiography preoperatively to assess changes in ejection fraction (EF), right ventricular systolic pressure (RVSP), and diastolic filling (E/e’). The patients were also followed for the postoperative course and hospital outcomes. All these data were compared to a historical cohort of 94 non-COVID-19 patients. Results There were no differences in mean age in post-COVID 65.2±11.6 vs. non-COVID-19 group 63.9±11.7, p = 0.57 or sex 74.6% vs. 70.7% of males, p = 0.38 or BMI 28.9± 4.5 vs. 28.2 ± 3.9, p = 0.42, with borderline significance in Euroscore 3 ± 4 vs. 1.6 ± 1.8, p = 0.05. retrospectively. Post-COVID-19 patients had a significantly higher prevalence of symptomatic HF 43.3% vs. 21.4%, p = 0.03, and AF 37.1% vs. 17%, p = 0.02 on admission. There were no significant differences between post-COVID-19 and COVID-19 in EF 56.9 ± 10.2 vs. 53.5 ± 12.6, p = 0.2, RVSP 38.1 ± 13.1 vs. 44.9 ± 12.8, p = 0.1 or E/e’ 13.8 ± 4.4 vs. 56.9 ± 10.2, p = 0.9. There were no significant differences in postoperative outcomes when post-COVID-19 group was compared to the non-COVID-19 group, the incidence of pneumonia was 8.6 vs. 6.9, p = 0.7, sepsis 2.9 vs. 4.3, p = 0.58, stroke 0% vs. 6.4%, p = 0.14, acute kidney failure 2.9 vs. 1.1, p = 0.47, postoperative acute MI 2.9% vs. 0%, p = 0.1, and mortality 0% vs. 1.1%, p = 0.5, retrospectively. There was a significantly higher incidence of transfusion in the post-COVID-19 group 77.1% vs. 41.5%, p < 0.01. Hospital stay for post-COVID-19 patients was 8.8 ± 4.4, vs. 8.7 ± 4 days, p = 0.94, total hospital stay 13 ± 7.4, vs. 11.4 ± 4.5, p = 0.2 and ICU stay 31.4 ± 37.8, vs. 44.4 ± 32.4 hours, p = 0.13. Conclusions Patients with severe valvular heart disease after COVID-19 are prone to develop heart failure and atrial fibrillation. The post-COVID-19 period following cardiac surgery is not associated with increased postoperative complications.