COVID-19 Positive Cohort Undergoing Cardiac Surgery: A Possible Un(3H)oly Trinity of Hypoxia-Hemolysis-Hyperinflammation

While the fraternity continues to ponder on the mechanisms by which coronavirus disease (COVID-19) positivity affects the outcome of cardiac surgical subset, we put forth a 3H (Hypoxia-Hemolysis-Hyperinflammation) trilogy aimed at elucidating the liaison between cardiopulmonary bypass (commonly employed for cardiac surgical conduct) and COVID-19 infection. A sound comprehension of the same can doubtlessly assist the perioperative team in staging a well-directed pathophysiology-driven management approach.

Keywords:
Covid-19; SARS-CoV-2; Cardiopulmonary Bypass; Hemolysis; Comprehension; Hypoxia

Authorship

Rohan Magoon

Department of Cardiac Anaesthesia, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital, Baba Kharak Singh Marg, New Delhi, India.Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital, Baba Kharak Singh MargIndiaNew Delhi, IndiaDepartment of Cardiac Anaesthesia, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital, Baba Kharak Singh Marg, New Delhi, India.

Ramesh Kashav

Jes Jose

Department of Anaesthesia, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital, Baba Kharak Singh Marg, New Delhi, India.Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital, Baba Kharak Singh MargIndiaNew Delhi, IndiaDepartment of Anaesthesia, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital, Baba Kharak Singh Marg, New Delhi, India.

Ashish Walian

Souvik Dey

https://orcid.org/0000-0001-8697-6423

Correspondence Address: Souvik Dey https://orcid.org/0000-0001-8697-6423 Department of Cardiac Anaesthesia, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital, Baba Kharak Singh Marg, New Delhi, India - Zip code: 110001 E-mail: souvik_23march@yahoo.co.in

This study was carried out at the Department of Cardiac Anaesthesia, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital, Baba Kharak Singh Marg, New Delhi, India.

No conflict of interest.

SCIMAGO INSTITUTIONS RANKINGS

Figures | Tables

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Tables (2)

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Fig. 1
- Illustration of the 3H (Hypoxia-Hemolysis-Hyperinflammation) trimodal insult owing to a double hit by COVID-19 (represented in pink) and CPB (represented in yellow). ARDS=acute respiratory distress syndrome; CPB=cardiopulmonary bypass; HIF=hypoxia-inducible factor; NFκB=nuclear factor-kappa B

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Abbreviations, acronyms & symbols

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Authors' roles & responsibilities

Fig. 1 - Illustration of the 3H (Hypoxia-Hemolysis-Hyperinflammation) trimodal insult owing to a double hit by COVID-19 (represented in pink) and CPB (represented in yellow). ARDS=acute respiratory distress syndrome; CPB=cardiopulmonary bypass; HIF=hypoxia-inducible factor; NFκB=nuclear factor-kappa B

Abbreviations, acronyms & symbols

ARDS	= Acute respiratory distress syndrome
CPB	= Cardiopulmonary bypass
COVID-19	= Coronavirus disease
DIC	= Disseminated intravascular coagulation
HIF	= Hypoxia-inducible factor
IL-6	= Interleukin-6
LDH	= Lactate dehydrogenase
PPE	= Personal protective equipment
NFκB	= Nuclear factor kappa B
SARS-CoV-2	= Severe acute respiratory syndrome coronavirus 2
TNF-α	= Tumour necrosis factor alpha

Authors' roles & responsibilities

RM	Substantial contributions to the conception or design of the work; or the acquisition, analysis or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published
RK	Drafting the work or revising it critically for important intellectual content; final approval of the version to be published
JJ	Substantial contributions to the conception or design of the work; or the acquisition, analysis or interpretation of data for the work; final approval of the version to be published
AW	Drafting the work or revising it critically for important intellectual content; final approval of the version to be published
SD	Substantial contributions to the conception or design of the work; or the acquisition, analysis or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published

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COVID-19 Positive Cohort Undergoing Cardiac Surgery: A Possible Un(3H)oly Trinity of Hypoxia-Hemolysis-Hyperinflammation

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[1] Correspondence Address: Souvik Dey https://orcid.org/0000-0001-8697-6423 Department of Cardiac Anaesthesia, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital, Baba Kharak Singh Marg, New Delhi, India - Zip code: 110001 E-mail: souvik_23march@yahoo.co.in