A 48-Year-Old Man at Low Risk for SARS-CoV-2 Infection Who Underwent Planned Elective Triple-Vessel Coronary Artery Bypass Graft Surgery at a National Heart Center in Indonesia Followed by a Fatal Case of COVID-19

Soetisna, Tri Wisesa; Buana, Andhika Citra; Tirta, Edward Suryadi; Ardiyan, Ardiyan; Aligheri, Dicky; Herlambang, Bagus; Tjubandi, Amin; Hanafy, Dudy Arman; Sugisman, Sugisman

Patient: Male, 48-year-old Final Diagnosis: Chronic kidney disease • coronary artery disease • COVID-19 Symptoms: Chest pain • fever • shorthness of breath Medication: — Clinical Procedure: Coronary artery bypass graft surgery Specialty: Cardiac surgery OBJECTIVE: Rare co-existance of disease or pathology BACKGROUND: This is of the first fatal case of coronavirus disease 2019 (COVID-19) pneumonia at a National Heart Center in Indonesia following planned elective triple-vessel coronary artery bypass graft (CABG) who was considered to be at low risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection when admitted for surgery. CASE REPORT: A 48-year-old man was diagnosed with coronary artery disease (CAD) in 3 vessels (3VD) with an ejection fraction (EF) of 61% and chronic kidney disease (CKD) with routine hemodialysis. The patient was scheduled for a coronary artery bypass graft (CABG) surgery. He underwent surgery after COVID-19 screening using a checklist provided by the hospital. The patient’s condition worsened on the 3rd postoperative day in the ward, and he was transferred back to the Intensive Care Unit (ICU), reintubated, and tested for COVID-19 with a real time-polymerase chain reaction (PCR) test. Because of the COVID-19 pandemic, we excluded the other possible pneumonia causes (e.g., influenza). An RT-PCR test performed after surgery revealed that the patient was positive for COVID-19. COVID-19 tracing was performed for all health care providers and relatives; all results were negative except for 1 family member. The patient was treated for 4 days in the isolation ICU but died due to complications of the infection. CONCLUSIONS: This report shows the importance of testing patients for SARS-CoV-2 infection before hospital admission for elective surgery and during the hospital stay, and the importance of developing rapid and accurate testing methods that can be used in countries and centers with limited health resources.