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Background COVID-19 pandemic is having a collateral health effect on delivery of surgical therapies and reports from management and maintaining surgical care are little. Purpose Investigate the impact of COVID-19 in our cardiac surgical ward and practice by scoping review of the last two years of activity, between 1st March 2019 and 28th February 2021. Methods Our Hospital is a private institution accredited with the National Health Service with a global volume load of 750 cardiac cases per year. We analized the pre-pandemic and the ongoing pandemic period on volume activity, the capacity of satisfying the needs of cardiosurgical patient and the mortality rate. Results We observed a minimal cardiac surgery caseload decline of 14.8%, probably due to environmental factor, the absence of E.D. in our institute, the rapid re-organization pathways, the hospital surveillance, the supply of personal protective equipment, the informative measures to improve patient and personnel welfare. In order to enhance the pshycological impact of this devastating event, we invited all the health workers to fill a questionnaire regarding concerns and worries about the risk of transmitting the infection to their families or to aquire it themselves. Conclusion During this devastating pandemic the rapid response in re-organization pathways and hospital surveillance allowed us to preserve the cardiac surgery volume of life-saving and non deferrable cases. Funding Acknowledgement Type of funding sources: None.

Introduction For some individuals infection with SARS-CoV-2 leading to COVID-19 can result in a life-threatening multi-system disease. Multiple potential pathophysiological mechanisms for the development of cardiovascular complications have been postulated [1]. Early reports suggested that more than a third of hospitalised patients undergoing TTE had evidence of LV impairment [2]. Purpose To ascertain the incidence of ventricular impairment among critically ill adults with COVID-19 admitted to the intensive care unit (ICU). Methods Retrospective analysis of transthoracic echocardiograms (TTE) performed on patients admitted to ICU with COVID-19 between 10th March and 10th May 2020. Archived studies were reviewed by accredited professionals. Studies were performed according to a modified British Society of Echocardiography (BSE) Level 1 protocol [3], with the addition of right ventricle (RV) focused apical 4 chamber, as well as apical 2 and 3 chamber views, and without ECG synchronisation as per infection control protocols. In the majority of patients the left ventricular ejection fraction (LVEF) was estimated from biplane Simpson's method. The RV function was assessed using the TAPSE in most patients. In the remaining patients the LV or RV function was visually assessed. Results Of 179 patients admitted to ICU, 85 (47.5%) had at least one TTE of diagnostic quality. Studies were performed a median of 7 days after ICU admission (IQR 3–17 days). Baseline and clinical characteristics and key echocardiographic measurements are summarised in table 1. The majority of patients were undergoing mechanical ventilation at the time of the scan (94.1%). One hundred and fifty-nine patients (89%) had elevated Troponin T (≥14ng/L) on the day of the study. LV systolic impairment (LVSD) was present in 5 patients (6.0%). This was known to be chronic in 3 patients (1 with coronary artery disease, 1 with chemotherapy induced cardiomyopathy and 1 with dilated cardiomyopathy of unknown aetiology), whilst pre-morbid cardiac function was unknown in the other 2 patients. No patient had severe LVSD (LVEF ≤35%). RV systolic dysfunction (RVSD) was found in 25 patients (31.3%). Amongst patients receiving mechanical ventilation there was no significant difference in Positive End Expiratory Pressure (PEEP) between patients with and without RVSD (9.4cmH2O vs. 9.8cmH2O, p=0.64), however there was a non-significant trend towards lower PaO2/FiO2 (P/F ratio) amongst patients with RVSD (18.9kPa vs 25.7kPa, p=0.07). Conclusions In contrast to other studies which have reported high frequency of LV impairment amongst hospitalised patients with COVID-19 [3], de novo LVSD was rarely found in this study, occurring in just 2 patients (2.4%), and being severe in neither. RV dilatation and systolic impairment were commonly found. A trend towards lower P/F ratios in patients with RVSD suggests severity of lung injury may be a factor in developing RV impairment. Funding Acknowledgement Type of funding sources: None.

Background Describe echocardiographic characteristics in patients admitted to an intensive care unit by COVID-19 and identify clinical and laboratory findings associated with an abnormal echocardiogram and its association with in-hospital mortality. Methods Included all patients with RT-PCR-confirmed COVID-19 who underwent echocardiography during hospitalization. Echocardiographic characteristics were assessed in the entire population and subgroups. We also analyzed clinical characteristics associated with an abnormal echocardiogram. An echocardiogram was defined as abnormal when it demonstrates systolic ventricular dysfunction of any degree (left and/or right ventricle) and/or high filling pressures (E/E' ratio>16; SPAP>40mmHg, RAP>15mmHg or diastolic dysfunction ≥ grade 2) and/or moderate to severe pericardial effusion. Clinical variables were also assessed using a classification tree and binary logistic regression was performed with characteristics that showed a statistical significance in univariate analysis. Finally, echocardiographic variables were assessed for in-hospital mortality outcome using the chi-square test. Results 272 admissions to ICU by COVID-19 were identified. Of these, 159 underwent echocardiography (58.5%). 39 were excluded by incomplete demographic data. 72 echocardiograms (60%) were abnormal according to pre-established criteria. Low occurrence of left and right ventricular systolic dysfunction was observed, as well as 30.8% of the population had a normal diastolic function. In univariate analysis, characteristics associated with abnormal echocardiogram were age, elevated troponin, previous heart failure, and SAPS3 score. In the regression model, troponin was the independent marker of abnormal echocardiography in patients admitted to the intensive care unit by COVID19. This finding was corroborated by the classification tree. The abnormal echocardiogram was not associated with in-hospital mortality (OR 1.60; CI95% 0.75–3.41), but the presence of systolic ventricular dysfunction of any degree was associated with a higher occurrence of this outcome (OR 3.52; CI95% 1.12–11.1). Conclusions In intensive care COVID-19 patients, many manifested elevated ventricular filling pressures, but the occurrence of ventricular dysfunction was low. Elevated serum troponin level was the independent marker associated with an abnormal echocardiogram. Systolic ventricular dysfunction was the only echocardiographic variable associated with in-hospital mortality. Funding Acknowledgement Type of funding sources: None.

Background Some studies have shown a higher prevalence of deaths in patients with cardiovascular risk factors (CRF) during hospitalization for COVID-19. The impact of high cardiovascular risk on hospital mortality has not been evaluated. Methods Retrospective study with patients admitted to intensive care and confirmed diagnosis of COVID-19 by RT-PCR and with at least one measurement of troponin during hospitalization. The criteria for defining a high cardiovascular risk patient (HCR) were: history of established cardiovascular disease (myocardial infarction, stroke, or peripheral arterial disease), diabetes, chronic kidney disease with clearance 65 years). The population was divided into 4 groups according to the presence of HCR and elevated troponin. Mortality was assessed using the chi-square method, according to the number of CRF, and was assessed in the 4 predetermined groups through logistic regression adjusted for severity (using the SAPS3 score). Results After evaluating 271 admissions during the study period, 236 patients were included for analysis. The mean age was 61.14±16.2 years, with 63.1% men. The prevalence of hypertension was 55.5% and diabetes, 33.1%. 47.4% of the patients had HCR. There was a significant increase in mortality as the number of risk factors increased (no CRF: 5.9%; 1 CRF: 17.5%; 2 CRF: 32.2% and ≥3 CRF: 41.2%; p=0.001). In logistic regression, patients with high cardiovascular risk and high troponin had a higher incidence of hospital mortality (OR 40.38; 95% CI 11.78–138.39). Patients without high cardiovascular risk, but with high troponin also showed a significant association with the primary outcome (OR 16.7; 95% CI 4.45–62.74). In contrast, patients with high cardiovascular risk and normal troponin were not at higher risk of death (OR 2.06; 95% CI 0.56–7.56). Conclusion In patients admitted to intensive care by COVID-19, the high cardiovascular risk impacts on hospital mortality only in patients who presented an increase in troponin levels. Funding Acknowledgement Type of funding sources: None.

Background The prognostic effect of the mean serum D-dimer levels, which was calculated from the first five hospitalization days of the patients, have not been elucidated. We aim to evaluate the effect of mean D-dimer level in regard to in-hospital mortality in patients hospitalized due to COVID-19 infection. Material and methods In this observational retrospective study, we examined the in-hospital prognostic value of mean D-dimer (D-dimer first day + D-dimer third day + D-dimer fifth day) / 3 on 240 consecutive adult patients with COVID-19. Patients were stratified into tertiles according to their mean D-dimer starting from the lowest one. In-hospital mortality rates were compared between tertiles and the power of the mean D-dimer level was also presented by a receiver operating curve (ROC) analysis. Results After adjustment for confounding baseline variables, mean D-dimer in tertile 3 was associated with an 4.2-fold hazard ratio of in-hospital mortality (OR: 4.2, 95% CI 1.8–20.1, p Conclusion Patients with a higher mean D-dimer level should be followed-up more closely since they may be a candidate for a more aggressive treatment modality, such as biologic agents or convalescent plasma. Funding Acknowledgement Type of funding sources: None. Figure 1