Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

The effect of cyclosporin- A on peri- operative myocardial injury in adult patients undergoing coronary artery bypass graft surgery:a randomised controlled clinical trial

OBJECTIVE: Cyclosporin-A (CsA) has been reported to reduce myocardial infarct size in both the experimental and clinical settings. This protective effect is dependent on its ability to prevent the opening of the mitochondrial permeability transition pore, a critical determinant of cell death in the setting of acute ischaemia-reperfusion injury. Whether CsA can reduce the extent of peri-operative myocardial injury (PMI) in patients undergoing coronary artery bypass graft (CABG) surgery is unknown, and is investigated in this randomised controlled clinical trial. METHODS: 78 adult patients undergoing elective CABG surgery were randomised to receive either an intravenous bolus of CsA (2.5 mg/kg) or placebo administered after induction of anaesthesia and prior to sternotomy. PMI was assessed by measuring serum cardiac enzymes, troponin T (cTnT) and CK-MB at 0, 6, 12, 24, 48 and 72 h after surgery. RESULTS: There was no significant difference in mean peak cTnT levels between control (n=43) and CsA treatment (n=40) patients (0.56±0.06 ng/mL with control vs 0.35±0.05 ng/mL with CsA; p=0.07). However, in higher-risk patients with longer cardiopulmonary bypass times, there was a significant reduction in PMI with CsA therapy (p=0.049), with a reduced postoperative cTnT rise by 0.03 ng/mL for every 10 min, when compared with control. CONCLUSIONS: In patients with longer cardiopulmonary bypass times, a single intravenous bolus of CsA administered prior to CABG surgery reduced the extent of PMI

014 Atorvastatin protects human myocardium from lethal ischaemia-reperfusion injury by activating the risk pathway

Background Previous animal studies have demonstrated that acute treatment with atorvastatin at reperfusion reduces myocardial infarct size by up-regulating the Akt and Erk1/2 components of the Reperfusion Injury Salvage Kinase (RISK) pathway. Whether this cardioprotective strategy applies to human cardiac tissue is unknown.Objective To determine whether atorvastatin, administered at reperfusion, protects human atrial tissue from ischaemia-reperfusion injury (IRI) via activation of the RISK pathway.Methods Local UCLH/UCL Ethical Committee approval was granted. Human atrial trabeculae were isolated from right atrial appendage tissue harvested from consenting adult patients undergoing elective cardiac surgery. The atrial trabeculae were subjected to 90 min of hypoxia followed by 120 min reoxygenation as simulated ischaemia-reperfusion injury. Following this, recovery of contractile function was determined and compared to baseline. Atrial trabeculae were randomised to the following groups: 1. Control (N=14); 2. Hypoxic preconditioning positive control (N=4); 3. Atorvastatin (25 μM) at reperfusion (N=9); 4. Atorvastatin plus UO126 (10 μM), a MEK1/2-Erk1/2 inhibitor (N=4); 5. Atorvastatin plus LY294002 (15 μM), a PI3K-Akt inhibitor (N=4); 6. Atorvastatin plus L-NAME (100 μM), a non-specific nitric oxide synthase inhibitor (N=7); 7. Atorvastatin plus 1400W (5μM), a specific inducible nitric oxide synthase inhibitor (N=5); 8. Inhibitor-only controls (N=18).Results Control atrial trabeculae recovered 37.5±1.6% of baseline contractile function following simulated IRI. Treatment with atorvastatin 25 μM at reperfusion significantly improved the recovery of contractile function (61.1±3.8%,

Special-Publication-Aquaculture-Association-of-Canada 5 39 42 St. Andrews, Canada: Aquaculture Association of Canada

Piscine nodaviruses are frequently being reported from a variety of cultured and wild finfish. These pathogens are responsible for viral encephalopathy and retinopathy (VER), also known as viral nervous necrosis (VNN) or fish encephalitis. Recently, nodavirus infections have posed serious problems for larval and juvenile cultured halibut, Hippoglossus hippoglossus in Norway and Scotland. To date, no such viruses have been described from any cultured or wild pleuronectids in Atlantic Canada, however, surveys of wild populations of pleuronectids are required to accurately assess the risk of potential transfer of nodavirus from wild to caged halibut. This paper presents the results of monthly surveys (April 2000 - March 2001) of viruses from wild winter flounder, Pleuronectes americanus, collected from Passamaquoddy Bay, New Brunswick, Canada. We detected nodavirus from only one out of 440 flounder (0.23%) examined. This is the first report of piscine nodavirus isolated from wild winter flounder in Atlantic Canada and although this prevalence may seem low, we discuss the implications of this finding for our emerging 'alternative species' aquaculture industry.