Impact of Preoperative COVID-19 Infection on Myocardial Injury and Outcomes After Aortic Valve Surgery in the Pre-Vaccination Era

Objectives To determine whether preoperative COVID-19 infection before vaccine introduction was associated with postoperative myocardial injury and long-term adverse outcomes after surgical aortic valve replacement. Methods This prospective cohort study included patients undergoing surgical aortic valve replacement between July 2020 and May 2021. Preoperative COVID-19 infection status was determined by antibody testing. Baseline data were collected, and outcomes were identified through structured medical-record review. The primary endpoint was a composite of major adverse cardiovascular events and all-cause mortality. Kaplan–Meier curves, Cox proportional hazards regression and logistic regression were used. Models were adjusted for age, preoperative heart failure, hypertension, diabetes, prior percutaneous coronary intervention and concomitant aneurysm surgery. Postoperative creatine kinase myocardial band within 24 h was analysed in relation to infection status, extracorporeal circulation time and aortic cross-clamp time. Results Ninety-nine patients were included; 15 had prior COVID-19 infection and 84 did not. Median follow-up was 3.4 years. The primary endpoint occurred in 2/15 patients with prior COVID-19 infection (13.3%) and 4/84 patients without prior COVID-19 infection (4.7%; P = .5). Adjusted estimates were numerically higher but non-significant for patients with prior COVID-19 infection (hazard ratio 6.6, 95% confidence interval 0.3-109, P = .1; odds ratio 6.6, 95% confidence interval 0.7-65, P = .3), whereas age was associated with outcome (hazard ratio 1.1/year, 95% confidence interval 1.0-1.4, P = .03). Creatine kinase myocardial band was associated with extracorporeal circulation time (coefficient 0.003/min, 95% confidence interval 0.002-0.004, P < .001) and aortic cross-clamp time (coefficient 0.004/min, 95% confidence interval 0.003-0.005, P < .001), without significant interaction with infection. Conclusions Preoperative COVID-19 infection was not significantly associated with long-term outcome, whereas age was associated with adverse outcome. CK-MB appeared more closely linked to operative ischaemic burden than prior COVID-19 infection.