tetano
Editor, Senior Moderator
J Am Heart Assoc
. 2023 Aug 17;e029406.
doi: 10.1161/JAHA.123.029406. Online ahead of print.
Effect of Cardiopulmonary Bypass on SARS-CoV-2 Vaccination Antibody Levels
Raymond J Strobel[SUP] 1 [/SUP], Adishesh K Narahari[SUP] 2 [/SUP], Evan P Rotar[SUP] 1 [/SUP], Andrew M Young[SUP] 1 [/SUP], Jeffrey Vergales[SUP] 3 [/SUP], J Hunter Mehaffey[SUP] 1 [/SUP], Nicholas R Teman[SUP] 1 [/SUP], John A Kern[SUP] 1 [/SUP], Leora T Yarboro[SUP] 1 [/SUP], Irving L Kron[SUP] 1 [/SUP], Michael R Nelson[SUP] 4 [/SUP], Mark Roeser[SUP] 1 [/SUP]
Affiliations
Background Adults undergoing heart surgery are particularly vulnerable to respiratory complications, including COVID-19. Immunization can significantly reduce this risk; however, the effect of cardiopulmonary bypass (CPB) on immunization status is unknown. We sought to evaluate the effect of CPB on COVID-19 vaccination antibody concentration after cardiac surgery. Methods and Results This prospective observational clinical trial evaluated adult participants undergoing cardiac surgery requiring CPB at a single institution. All participants received a full primary COVID-19 vaccination series before CPB. SARS-CoV-2 spike protein-specific antibody concentrations were measured before CPB (pre-CPB measurement), 24 hours following CPB (postoperative day 1 measurement), and approximately 1 month following their procedure. Relationships between demographic or surgical variables and change in antibody concentration were assessed via linear regression. A total of 77 participants were enrolled in the study and underwent surgery. Among all participants, mean antibody concentration was significantly decreased on postoperative day 1, relative to pre-CPB levels (-2091 AU/mL, P<0.001). Antibody concentration increased between postoperative day 1and 1 month post CPB measurement (2465 AU/mL, P=0.015). Importantly, no significant difference was observed between pre-CPB and 1 month post CPB concentrations (P=0.983). Two participants (2.63%) developed symptomatic COVID-19 pneumonia postoperatively; 1 case of postoperative COVID-19 pneumonia resulted in mortality (1.3%). Conclusions COVID-19 vaccine antibody concentrations were significantly reduced in the short-term following CPB but returned to pre-CPB levels within 1 month. One case of postoperative COVID 19 pneumonia-specific mortality was observed. These findings suggest the need for heightened precautions in the perioperative period for cardiac surgery patients.
Keywords: cardiac surgery; cardiopulmonary bypass; coronavirus disease 2019.
. 2023 Aug 17;e029406.
doi: 10.1161/JAHA.123.029406. Online ahead of print.
Effect of Cardiopulmonary Bypass on SARS-CoV-2 Vaccination Antibody Levels
Raymond J Strobel[SUP] 1 [/SUP], Adishesh K Narahari[SUP] 2 [/SUP], Evan P Rotar[SUP] 1 [/SUP], Andrew M Young[SUP] 1 [/SUP], Jeffrey Vergales[SUP] 3 [/SUP], J Hunter Mehaffey[SUP] 1 [/SUP], Nicholas R Teman[SUP] 1 [/SUP], John A Kern[SUP] 1 [/SUP], Leora T Yarboro[SUP] 1 [/SUP], Irving L Kron[SUP] 1 [/SUP], Michael R Nelson[SUP] 4 [/SUP], Mark Roeser[SUP] 1 [/SUP]
Affiliations
- PMID: 37589123
- DOI: 10.1161/JAHA.123.029406
Background Adults undergoing heart surgery are particularly vulnerable to respiratory complications, including COVID-19. Immunization can significantly reduce this risk; however, the effect of cardiopulmonary bypass (CPB) on immunization status is unknown. We sought to evaluate the effect of CPB on COVID-19 vaccination antibody concentration after cardiac surgery. Methods and Results This prospective observational clinical trial evaluated adult participants undergoing cardiac surgery requiring CPB at a single institution. All participants received a full primary COVID-19 vaccination series before CPB. SARS-CoV-2 spike protein-specific antibody concentrations were measured before CPB (pre-CPB measurement), 24 hours following CPB (postoperative day 1 measurement), and approximately 1 month following their procedure. Relationships between demographic or surgical variables and change in antibody concentration were assessed via linear regression. A total of 77 participants were enrolled in the study and underwent surgery. Among all participants, mean antibody concentration was significantly decreased on postoperative day 1, relative to pre-CPB levels (-2091 AU/mL, P<0.001). Antibody concentration increased between postoperative day 1and 1 month post CPB measurement (2465 AU/mL, P=0.015). Importantly, no significant difference was observed between pre-CPB and 1 month post CPB concentrations (P=0.983). Two participants (2.63%) developed symptomatic COVID-19 pneumonia postoperatively; 1 case of postoperative COVID-19 pneumonia resulted in mortality (1.3%). Conclusions COVID-19 vaccine antibody concentrations were significantly reduced in the short-term following CPB but returned to pre-CPB levels within 1 month. One case of postoperative COVID 19 pneumonia-specific mortality was observed. These findings suggest the need for heightened precautions in the perioperative period for cardiac surgery patients.
Keywords: cardiac surgery; cardiopulmonary bypass; coronavirus disease 2019.