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\begin{document}

\title{Cardiac Surgery can be performed safely in patients with recent COVID-19
infection}



\author[1]{Ana Lopez-Marco}%
\author[1]{Martin Yates}%
\author[1]{Cristina Suarez}%
\author[1]{Azhar Hussain}%
\author[1]{Damian Balmforth}%
\author[1]{Robert Serafino Wani}%
\author[1]{Satya Das}%
\author[1]{Aung Oo}%
\affil[1]{Saint Bartholomew's Hospital}%


\vspace{-1em}



  
  \date{May 27, 2024}


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\selectlanguage{english}
\begin{abstract}
Surgery in patients diagnosed with COVID-19 infection carries
significant mortality and morbidity but the appropriate waiting period
before surgical intervention after recovering from COVID-19 is not
known. We analysed the outcomes of patients who underwent cardiac
surgery after having been diagnosed of COVID-19 on pre-operative
screening between March and July 2020. Depending on the clinical urgency
we delayed surgery until negative testing and/or radiological clearance
or postponed the operation where possible. As a result of waiting until
COVID-19 resolution, all of our patients survived surgery without
complications.%
\end{abstract}%



\sloppy


\emph{INTRODUCTION}

Reports describe high mortality and prolonged mechanical ventilation in
surgical patients who diagnosed with COVID-19 in the peri-operative
period {[}1-2{]}. In our own experience, developing COVID-19 in the
immediate postoperative period following cardiac surgery carried a
mortality up to 44\% {[}3{]}, mostly due to a combination of respiratory
and renal failure likely exacerbated by the inflammatory effects of
cardiopulmonary bypass.

Depending on the cardiac diagnosis, there might be an option to treat
the patients medically, with less invasive procedures (i.e. PCI, TAVI or
endovascular procedures) or to defer surgery until there is negative
conversion of COVID-19 status, not knowing the optimum time from
infection to cardiac surgery.

We analysed the outcomes of cardiac surgery in patients who underwent
cardiac surgery after recovering from COVID-19.

\emph{METHODS}

Analysis of all patients undergoing cardiac surgery in our centre from
March to July 2020, with focus on those diagnosed pre-operatively with
COVID-19 (either a positive nasopharyngeal swab or by changes in the
lung parenchyma on CT scan) and underwent subsequent surgery.

Our COVID-19 screening protocol consists of two consecutive
nasopharyngeal swabs for polymerase chain reaction for ribonucleic acid
(PCR-RNA) analysis by The Cobas SARS-CoV-2 (targeting virus Orf and E
genes and is declared positive if either target was detected; it also
reports the cycle threshold (Ct value) or the number of cycles of
amplification before the PCR product is detected as positive), a
non-contrast CT chest, lymphocyte count and Lactate Dehydrogenase (LDH)
levels {[}4{]}.

Individual patient's consent was waived by the Ethics Institutional
Board since there was no patient identifiable data.

\emph{RESULTS}

During the study period a total of 375 patients underwent cardiac
surgery in our institution.

Ten patients were diagnosed with COVID-19 in the preoperative screening
and subsequently underwent surgery: 4 patients by a positive
nasopharyngeal swab, 3 by CT changes in the lung parenchyma and 3 by a
combination.

Male sex predominated (80\%) and mean age was 65.8 (45 -- 76) years.
Cardiac diagnosis included: acute coronary syndrome (n=5), acute aortic
syndrome (n=1), decompensated mitral regurgitation (n=1), symptomatic
severe aortic stenosis (n=1), infective endocarditis (n=1) and infected
aortic graft (n=1). (Table 1)

All the patients were discussed at MDTs with input from
virologist/infection specialist. In all cases it was agreed that the
optimal treatment was surgery without possibility for a less invasive
approach.

Four patients were discharged home with medical therapy and readmitted
for elective surgery. Mean delay to surgery was 67 (50 -- 84) days.

Six patients required urgent treatment during the same admission. Mean
delay to surgery was 14.7 (4 -- 31) days. They were kept in isolation in
a specialised cardiac unit and the screening was repeated every 48 hours
until negative tests were obtained and/or the infiltrates disappeared on
CXR.

None of the patients developed pyrexia while waiting for the operation
and only one patient developed dyspnoea, probably due to acute heart
failure.

Mean Euroscore was 3.3 (1.09 -- 7.93). Surgical procedures were: CABG
(n= 4), CABG + mitral replacement (n= 1), mitral repair (n= 1), AVR (n=
2), aortic replacement (n= 2). Mean bypass and cross clamp time was
122.4 (67 -- 305) and 82.8 (36 -- 158) minutes respectively. All
surgeries were conducted with PPE precautions.

None of the patients developed respiratory complications in the
postoperative period and were extubated uneventfully in the first two
days. Mechanical ventilation times and length of postoperative stay were
not prolonged. Postoperative swabs were negative for all patients.

All patients survived to hospital discharge. (Table 2).

\emph{DISCUSSION}

Developing COVID-19 during the immediate postoperative period,
regardless of the nature of surgery, carries a high mortality and
morbidity related to respiratory complications {[}2-4{]}.

In emergencies there is no option to wait for the swab results, hence
the surgical indication outweighs the risk of COVID-19. However, in
urgent cases, with margin to wait for the screening results we
encountered a proportion of patients who were COVID-19 positive with
mild or no symptoms.

The ideal convalescence period after having tested positive for COVID-19
is unknown, especially if no symptoms or abnormalities in the chest
imaging. We believe it is important to manage each case individually,
and when time permitting, to wait until negative for COVID-19 testing or
drastically reduced viral load and resolution of the radiological
infiltrates (if any).

Accuracy of the COVID-19 diagnostic tests is still suboptimal, with a
high percentage of false negatives. Furthermore, a positive test does
not necessarily indicate infectious virus particles in a patient with
resolving infection. The Ct value can be seen as a pseudo-measure of the
viral load (the lower the Ct value, the higher the viral concentration)
and patients with COVID-19 with Ct above 24-26 could be considered
non-contagious {[}5{]}.

In our series, all patients who required urgent surgery had Ct values
above that threshold and were probably not infectious but delaying
surgery also allowed resolution of the systemic inflammatory reaction
and thus did not see any postoperative complications.

It might not be necessary to wait until total resolution of radiological
changes or a negative PCR result but further studies on a larger volume
of patients are needed to confirm this.

\emph{CONCLUSIONS}

Postponing cardiac surgery in selected patients with confirmed COVID-19
was safe and enabled surgery to be performed with favourable outcomes in
patients with low viral load and radiological resolution of lung
infiltrates.

TABLES\selectlanguage{english}
\begin{longtable}[]{@{}llllllll@{}}
\toprule
\begin{minipage}[b]{0.12\columnwidth}\raggedright\strut
\textbf{Patient}\strut
\end{minipage} & \begin{minipage}[b]{0.12\columnwidth}\raggedright\strut
\textbf{Sex}\strut
\end{minipage} & \begin{minipage}[b]{0.12\columnwidth}\raggedright\strut
\textbf{Age}\strut
\end{minipage} & \begin{minipage}[b]{0.12\columnwidth}\raggedright\strut
\textbf{Diagnosis}\strut
\end{minipage} & \begin{minipage}[b]{0.12\columnwidth}\raggedright\strut
\textbf{Modality of COVID-19 diagnosis}\strut
\end{minipage} & \begin{minipage}[b]{0.12\columnwidth}\raggedright\strut
\textbf{Delay to surgery} \textbf{(days)}\strut
\end{minipage} & \begin{minipage}[b]{0.12\columnwidth}\raggedright\strut
\textbf{Surgery}\strut
\end{minipage} & \begin{minipage}[b]{0.12\columnwidth}\raggedright\strut
\textbf{EuroScore II}\strut
\end{minipage}\tabularnewline
\midrule
\endhead
\begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
1\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
M\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
68\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Infective endocarditis\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Swab\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
31\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Aortic valve replacement\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
1.59\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
2\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
M\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
61\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
STEMI\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Swab + CT chest\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
16\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
CABG\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
1.09\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
3\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
M\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
59\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Expanding DTA aneurysm\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Swab\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
5\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
DTA replacement\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
3.91\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
4\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
M\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
45\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Infected aortic graft\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Swab + CT chest\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
18\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Ascending aorta replacement\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
7.93\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
5\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
M\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
71\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Non STEMI\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Swab\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
71\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
CABG\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
1.09\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
6\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
M\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
75\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Non STEMI + pulmonary oedema\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
CT chest\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
9\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
CABG + Mitral valve replacement\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
7.15\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
7\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
F\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
76\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Severe mitral regurgitation\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
CT chest\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
63\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Mitral repair\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
2.42\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
8\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
F\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
69\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Severe aortic stenosis\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
CT chest\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
50\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Aortic valve replacement\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
3.54\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
9\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
M\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
63\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Unstable angina\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Swab + CT chest\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
9\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
CABG\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
1.03\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
10\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
M\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
71\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
STEMI\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
Swab\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
84\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
CABG\strut
\end{minipage} & \begin{minipage}[t]{0.10\columnwidth}\raggedright\strut
4.06\strut
\end{minipage}\tabularnewline
\bottomrule
\end{longtable}

Table 1. Demographics, cardiac diagnosis and surgery performed. Details
of the COVID-19 screening. CABG: Coronary artery bypass grafting; DTA:
descending thoracic aorta; STEMI: ST elevation myocardial infarction.\selectlanguage{english}
\begin{longtable}[]{@{}lllllllll@{}}
\toprule
\begin{minipage}[b]{0.11\columnwidth}\raggedright\strut
\textbf{Patient}\strut
\end{minipage} & \begin{minipage}[b]{0.11\columnwidth}\raggedright\strut
\textbf{COVID symptoms}\strut
\end{minipage} & \begin{minipage}[b]{0.11\columnwidth}\raggedright\strut
\textbf{Lowest} \textbf{Lymphocyte count}\strut
\end{minipage} & \begin{minipage}[b]{0.11\columnwidth}\raggedright\strut
\textbf{Highest} \textbf{LDH} \textbf{Value}\strut
\end{minipage} & \begin{minipage}[b]{0.11\columnwidth}\raggedright\strut
\textbf{Highest Ct value}\strut
\end{minipage} & \begin{minipage}[b]{0.11\columnwidth}\raggedright\strut
\textbf{CT changes} \textbf{Suggested of COVID}\strut
\end{minipage} & \begin{minipage}[b]{0.11\columnwidth}\raggedright\strut
\textbf{Mechanical ventilation times (hours)}\strut
\end{minipage} & \begin{minipage}[b]{0.11\columnwidth}\raggedright\strut
\textbf{Length of ITU admission} \textbf{(days)}\strut
\end{minipage} & \begin{minipage}[b]{0.11\columnwidth}\raggedright\strut
\textbf{Length of postoperative stay} \textbf{(days)}\strut
\end{minipage}\tabularnewline
\midrule
\endhead
\begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
1\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
No\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
0.5\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
350\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
37.74\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
No\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
8\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
3\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
14\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
2\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Dyspnoea\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
1.0\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
N/A\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
34.15\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Yes\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
6\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
3\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
5\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
3\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
No\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
1.6\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
177\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
35.14\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
No\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
24\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
4\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
9\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
4\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
No\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
0.6\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
N/A\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
37.24\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Yes\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
12\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
4\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
48\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
5\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
No\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
1.9\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
216\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
31.63\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
No\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
4\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
1\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
4\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
6\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
No\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
1.8\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
162\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
0\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Yes\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
4\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
1\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
6\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
7\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
No\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
2.2\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
285\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
0\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Yes\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
4\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
2\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
9\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
8\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
No\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
0.4\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
249\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
0\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Yes\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
5\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
7\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
12\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
9\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
No\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
0.5\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
N/A\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
0\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Yes\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
4\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
1\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
5\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
10\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
No\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
1.1\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
160\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
28.08\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
No\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
4\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
3\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
7\strut
\end{minipage}\tabularnewline
\bottomrule
\end{longtable}

Table 2. Presence of COVID-19 symptoms and screening adjuncts:
lymphocyte count and Lactate dehydrogenase (LDH) values, non-contrasted
chest computed tomography (CT). Postoperative outcomes: length of
intensive care (ITU) stay. Ct: cycle threshold. N/A (Not-available) -
haemolysed sample.

\emph{REFERENCES}

\begin{enumerate}
\tightlist
\item
  Cai Y, Hao Z, Gao Y, Ping W et al. Coronavirus disease 2019 in the
  perioperative period of lung resection: a brief report from a single
  thoracic surgery department in Wuhan. J Thorac Oncol. 2020;15:1065-72/
\item
  Lei S, Jiang F, Su W, Chen C et al. Clinical characteristics and
  outcomes of patients undergoing surgeries during the incubation period
  of COVID-19 infection. EClinicalMedicine. 2020;21:100331.
\item
  Yates M, Balmforth D, Lopez-Marco A, Uppal R et al. Outcomes of
  patients diagnosed with COVID-19 in the early post-operative period
  following cardiac surgery. Interact CardioVasc Thorac J Published
  online first 2020.
\item
  Hussain A, Balmforth D, Yates M, Lopez-Marco A et al. The Pan London
  Emergency Cardiac Surgery Service: Coordinating a response to the
  COVID-19 Pandemic. J Card Surg 2020;1-7.
\item
  La Scola B, Le Bideau M, Andreani J, Hoang VT et al. Viral RNA load as
  determined by cell culture as a management tool for discharge of
  SARS-CoV-2 patients from infectious disease wards. Eur J clin
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\end{enumerate}

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