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Medical Science Monitor Basic Research


A 48-Year-Old Man at Low Risk for SARS-CoV-2 Infection Who Underwent Planned Elective Triple-Vessel Coronary Artery Bypass Graft Surgery at a National Heart Center in Indonesia Followed by a Fatal Case of COVID-19

Challenging differential diagnosis, Unusual setting of medical care, Clinical situation which can not be reproduced for ethical reasons, Rare coexistence of disease or pathology

Tri Wisesa Soetisna, Andhika Citra Buana, Edward Suryadi Tirta, Ardiyan Ardiyan, Dicky Aligheri, Bagus Herlambang, Amin Tjubandi, Dudy Arman Hanafy, Sugisman Sugisman

Indonesia Department of Cardiothoracic and Vascular Surgery, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia

Am J Case Rep 2021; 22:e928900

DOI: 10.12659/AJCR.928900

Available online: 2020-12-08

Published: 2021-01-25


BACKGROUND: This is of the first fatal case of coronavirus disease 2019 (COVID-19) pneumonia at a National Heart Center in Indonesia following planned elective triple-vessel coronary artery bypass graft (CABG) who was considered to be at low risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection when admitted for surgery.
CASE REPORT: A 48-year-old man was diagnosed with coronary artery disease (CAD) in 3 vessels (3VD) with an ejection fraction (EF) of 61% and chronic kidney disease (CKD) with routine hemodialysis. The patient was scheduled for a coronary artery bypass graft (CABG) surgery. He underwent surgery after COVID-19 screening using a checklist provided by the hospital. The patient’s condition worsened on the 3rd postoperative day in the ward, and he was transferred back to the Intensive Care Unit (ICU), reintubated, and tested for COVID-19 with a real time-polymerase chain reaction (PCR) test. Because of the COVID-19 pandemic, we excluded the other possible pneumonia causes (e.g., influenza). An RT-PCR test performed after surgery revealed that the patient was positive for COVID-19. COVID-19 tracing was performed for all health care providers and relatives; all results were negative except for 1 family member. The patient was treated for 4 days in the isolation ICU but died due to complications of the infection.
CONCLUSIONS: This report shows the importance of testing patients for SARS-CoV-2 infection before hospital admission for elective surgery and during the hospital stay, and the importance of developing rapid and accurate testing methods that can be used in countries and centers with limited health resources.

Keywords: Coronary Artery Bypass, Coronary Artery Disease, COVID-19