Title : Impact of preoperative COVID 19 infection on myocardial injury and outcomes after aortic valve surgery in the pre vaccination era
Abstract:
Background: The long-term impact of preoperative SARS-CoV-2 infection on patients undergoing surgical aortic valve replacement (SAVR) remains insufficiently defined, particularly in the pre-vaccination era. This study investigated whether previous COVID-19, determined by serology on the day of surgery, was associated with postoperative myocardial injury and long-term adverse outcomes after SAVR.
Methods: We conducted a prospective follow-up study within DAVAACA including 99 patients who underwent SAVR at Karolinska University Hospital between 1 July 2020 and 31 May 2021. Patients were classified as antibody-positive (n=15) or antibody-negative (n=84). Baseline data and outcomes were collected through structured medical-record review. The primary endpoint was a composite of major adverse cardiovascular events (myocardial infarction, stroke, or cardiovascular death) and all-cause mortality. Kaplan-Meier analysis, multivariable Cox regression, and logistic regression were performed. Postoperative creatine kinase myocardial band (CK-MB) within 24 hours was evaluated in relation to infection status, extracorporeal circulation (ECC) time, and aortic cross-clamp (AXC) time.
Results: During a median follow-up of 3.4 years, the primary endpoint occurred in 2 of 15 antibody-positive patients (13.3%) and 4 of 84 antibody-negative patients (4.7%). The difference was not statistically significant in Kaplan-Meier analysis (log-rank p=0.51). Adjusted estimates were numerically higher among antibody-positive patients but remained non-significant (hazard ratio 6.6, 95% confidence interval 0.3-109.4, p=0.10; odds ratio 6.6, 95% confidence interval 0.7-65.4, p=0.30). Age independently predicted the primary endpoint (hazard ratio 1.1 per year, 95% confidence interval 1.0-1.4, p=0.03). Postoperative CK-MB did not differ significantly by antibody status, but was strongly associated with ECC time (β=0.003/min, 95% confidence interval 0.002-0.004, p<0.0001) and AXC time (β=0.004/min, 95% confidence interval 0.003-0.005, p<0.0001), without significant interaction by prior infection.
Conclusion: In this pre-vaccination SAVR cohort, prior SARS-CoV-2 infection was not significantly associated with long-term adverse outcomes, although higher risk estimates warrant cautious interpretation. Postoperative CK-MB appeared more closely linked to operative ischemic burden than prior infection.
