The impact of prior asymptomatic COVID-19 infection on outcomes following coronary bypass surgery.

Authors

Emre Külahcıoğlu, Muhammet Selim Yaşar, Erdal Şimşek

Published in

Journal of cardiothoracic surgery. Volume 21. Issue 1. Jul 29, 2026. Epub Jul 29, 2026.

Abstract

The optimal timing and expected postoperative course of coronary artery bypass grafting (CABG) after asymptomatic coronavirus disease 2019 (COVID-19) remain uncertain. Evidence guiding cardiac surgical practice has largely been extrapolated from mixed surgical cohorts or broader cardiac surgery series rather than from isolated CABG populations.
This retrospective single-center cohort study included adults who underwent isolated CABG during 2021-2022. Patients with documented asymptomatic preoperative SARS-CoV-2 infection were compared with patients without documented prior COVID-19. Preoperative, intraoperative, and postoperative variables were extracted from institutional records. Outcomes included early clinical recovery, respiratory support, transfusion exposure, laboratory trajectories, and mortality. A timing subgroup analysis (< 4 weeks vs >= 4 weeks from infection to surgery) was prespecified as exploratory.
Seventy-six patients met eligibility criteria: 37 with prior asymptomatic COVID-19 and 39 without documented prior COVID-19. The cohort was predominantly male (81.6%), low risk by EuroSCORE II, and largely elective. Baseline demographics, major comorbidities, ventricular function, operative priority, number of grafted vessels, cardiopulmonary bypass time, cross-clamp time, extubation time, intensive care unit stay, hospital stay, oxygen requirement, and transfusion exposure were similar between groups. Postoperative complications were more frequent in the prior-COVID group (16.2% vs 0.0%; risk difference 16.2%, 95% CI 3.8-31.1%; P = 0.011), whereas mortality remained rare and not significantly different (2.7% vs 0.0%; P = 0.487). Longitudinal laboratory analyses showed expected perioperative inflammatory and hematologic changes within both groups, without consistent between-group separation. In the exploratory timing subgroup, no statistically significant differences were detected between earlier and later surgery, but this analysis was markedly underpowered.
In this single-center exploratory cohort of predominantly elective, low-risk CABG patients, prior asymptomatic SARS-CoV-2 infection was not associated with a generalized worsening of early postoperative recovery, although postoperative complications were more frequent in the exposed group. These data are insufficient to inform CABG timing recommendations after asymptomatic infection and should not be extrapolated to unstable or higher-risk patients. Larger multicenter studies with better exposure characterization, vaccination data, and longer follow-up are required.

PMID:
42947228
Bibliographic data and abstract were imported from PubMed on 28 Oct 2026.

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