Retrospective record review on timing of COVID‐19 vaccination and cardiac surgery

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Abstract

Background

Novel clinical challenges are faced by cardiac surgeons under the coronavirus disease 2019 (COVID‐19) pandemic. Amidst the uncertainties faced due to the socioeconomic and public health impact, there is little evidence surrounding COVID‐19 vaccination in patients undergoing cardiac surgery. Timing of vaccination and postvaccination adverse effects are required parameters to discuss with cardiac surgical patients.

Methods

This is a single‐center, retrospective observational study. All patients who underwent adult cardiac surgery at the Prince of Wales Hospital, Hong Kong from January 2021 to December 2021 were included. Postoperative clinical outcomes, COVID‐19 vaccination status, and vaccination‐related adverse effects were collected.

Results

A total of 426 patients; 117 (27%) underwent isolated coronary artery bypass grafting, 111 (26%) underwent valvular surgery, and 97 (23%) underwent aortic surgery. Patients received either Sinovac CoronaVac or Pfizer BNT162b2 vaccine. Overall vaccination rate with at least 1 dose was 52% ( n = 212), 15% ( n = 63) received the first dose before surgery, 36% ( n = 149) received the first dose vaccination after surgery. Rate of completion with second and third doses of vaccination were 22% ( n = 89) and 4.9% ( n = 20), respectively. The mean timing of first dose of vaccine after surgery was 216 ± 84 days from operation. Three (1.4%) patients recorded vaccination‐related complications.

Conclusions

COVID‐19 vaccination is safe in patients who received major cardiac surgery, with low adverse effects recorded and no vaccine‐related mortality observed. A time frame of 3–6 months after cardiac surgery receiving COVID‐19 vaccination is reasonable and could serve as a guidance for future COVID‐19 vaccination booster programs.

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Most cited references 15

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Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine

Fernando P Polack, Stephen J. Thomas, Nicholas R.E. Kitchin … (2023)

Abstract Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the resulting coronavirus disease 2019 (Covid-19) have afflicted tens of millions of people in a worldwide pandemic. Safe and effective vaccines are needed urgently. Methods In an ongoing multinational, placebo-controlled, observer-blinded, pivotal efficacy trial, we randomly assigned persons 16 years of age or older in a 1:1 ratio to receive two doses, 21 days apart, of either placebo or the BNT162b2 vaccine candidate (30 μg per dose). BNT162b2 is a lipid nanoparticle–formulated, nucleoside-modified RNA vaccine that encodes a prefusion stabilized, membrane-anchored SARS-CoV-2 full-length spike protein. The primary end points were efficacy of the vaccine against laboratory-confirmed Covid-19 and safety. Results A total of 43,548 participants underwent randomization, of whom 43,448 received injections: 21,720 with BNT162b2 and 21,728 with placebo. There were 8 cases of Covid-19 with onset at least 7 days after the second dose among participants assigned to receive BNT162b2 and 162 cases among those assigned to placebo; BNT162b2 was 95% effective in preventing Covid-19 (95% credible interval, 90.3 to 97.6). Similar vaccine efficacy (generally 90 to 100%) was observed across subgroups defined by age, sex, race, ethnicity, baseline body-mass index, and the presence of coexisting conditions. Among 10 cases of severe Covid-19 with onset after the first dose, 9 occurred in placebo recipients and 1 in a BNT162b2 recipient. The safety profile of BNT162b2 was characterized by short-term, mild-to-moderate pain at the injection site, fatigue, and headache. The incidence of serious adverse events was low and was similar in the vaccine and placebo groups. Conclusions A two-dose regimen of BNT162b2 conferred 95% protection against Covid-19 in persons 16 years of age or older. Safety over a median of 2 months was similar to that of other viral vaccines. (Funded by BioNTech and Pfizer; ClinicalTrials.gov number, NCT04368728.)

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Effectiveness of an Inactivated SARS-CoV-2 Vaccine in Chile

Alejandro Jara, Eduardo Undurraga, Cecilia SENÉN GONZÁLEZ … (2021)

Background Mass vaccination campaigns to prevent coronavirus disease 2019 (Covid-19) are occurring in many countries; estimates of vaccine effectiveness are urgently needed to support decision making. A countrywide mass vaccination campaign with the use of an inactivated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine (CoronaVac) was conducted in Chile starting on February 2, 2021. Methods We used a prospective national cohort, including participants 16 years of age or older who were affiliated with the public national health care system, to assess the effectiveness of the inactivated SARS-CoV-2 vaccine with regard to preventing Covid-19 and related hospitalization, admission to the intensive care unit (ICU), and death. We estimated hazard ratios using the extension of the Cox proportional-hazards model, accounting for time-varying vaccination status. We estimated the change in the hazard ratio associated with partial immunization (≥14 days after receipt of the first dose and before receipt of the second dose) and full immunization (≥14 days after receipt of the second dose). Vaccine effectiveness was estimated with adjustment for individual demographic and clinical characteristics. Results The study was conducted from February 2 through May 1, 2021, and the cohort included approximately 10.2 million persons. Among persons who were fully immunized, the adjusted vaccine effectiveness was 65.9% (95% confidence interval [CI], 65.2 to 66.6) for the prevention of Covid-19 and 87.5% (95% CI, 86.7 to 88.2) for the prevention of hospitalization, 90.3% (95% CI, 89.1 to 91.4) for the prevention of ICU admission, and 86.3% (95% CI, 84.5 to 87.9) for the prevention of Covid-19–related death. Conclusions Our results suggest that the inactivated SARS-CoV-2 vaccine effectively prevented Covid-19, including severe disease and death, a finding that is consistent with results of phase 2 trials of the vaccine. (Funded by Agencia Nacional de Investigación y Desarrollo and others.)

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Risks of myocarditis, pericarditis, and cardiac arrhythmias associated with COVID-19 vaccination or SARS-CoV-2 infection

Martina Patone, Xue Mei, Lahiru Handunnetthi … (2021)

Although myocarditis and pericarditis were not observed as adverse events in coronavirus disease 2019 (COVID-19) vaccine trials, there have been numerous reports of suspected cases following vaccination in the general population. We undertook a self-controlled case series study of people aged 16 or older vaccinated for COVID-19 in England between 1 December 2020 and 24 August 2021 to investigate hospital admission or death from myocarditis, pericarditis and cardiac arrhythmias in the 1–28 days following adenovirus (ChAdOx1, n = 20,615,911) or messenger RNA-based (BNT162b2, n = 16,993,389; mRNA-1273, n = 1,006,191) vaccines or a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive test (n = 3,028,867). We found increased risks of myocarditis associated with the first dose of ChAdOx1 and BNT162b2 vaccines and the first and second doses of the mRNA-1273 vaccine over the 1–28 days postvaccination period, and after a SARS-CoV-2 positive test. We estimated an extra two (95% confidence interval (CI) 0, 3), one (95% CI 0, 2) and six (95% CI 2, 8) myocarditis events per 1 million people vaccinated with ChAdOx1, BNT162b2 and mRNA-1273, respectively, in the 28 days following a first dose and an extra ten (95% CI 7, 11) myocarditis events per 1 million vaccinated in the 28 days after a second dose of mRNA-1273. This compares with an extra 40 (95% CI 38, 41) myocarditis events per 1 million patients in the 28 days following a SARS-CoV-2 positive test. We also observed increased risks of pericarditis and cardiac arrhythmias following a positive SARS-CoV-2 test. Similar associations were not observed with any of the COVID-19 vaccines, apart from an increased risk of arrhythmia following a second dose of mRNA-1273. Subgroup analyses by age showed the increased risk of myocarditis associated with the two mRNA vaccines was present only in those younger than 40.

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Author and article information

Contributors

Randolph H. L. Wong:

ORCID: http://orcid.org/0000-0003-0027-459X

wonhl1@surgery.cuhk.edu.hk

Journal

Journal ID (nlm-ta): J Card Surg

Journal ID (iso-abbrev): J Card Surg

Journal ID (doi): 10.1111/(ISSN)1540-8191

Journal ID (publisher-id): JOCS

Title: Journal of Cardiac Surgery

Publisher: John Wiley and Sons Inc. (Hoboken )

ISSN (Print): 0886-0440

ISSN (Electronic): 1540-8191

Publication date (Electronic): 02 September 2022

Publication date (Print): November 2022

Publication date PMC-release: 02 September 2022

Volume: 37

Issue: 11 ( doiID: 10.1111/jocs.v37.11 )

Pages: 3634-3638

Affiliations

[ ¹ ] Division of Cardiothoracic Surgery, Department of Surgery Prince of Wales Hospital Shatin Hong Kong SAR China

Author notes

[*] [* ] Correspondence Randolph H. L. Wong, FRCS, Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR.

Email: wonhl1@ 123456surgery.cuhk.edu.hk

Author information

Jacky Y. K. Ho http://orcid.org/0000-0003-2339-0454

Song Wan http://orcid.org/0000-0002-9394-1672

Randolph H. L. Wong http://orcid.org/0000-0003-0027-459X

Article

Publisher ID: JOCS16883

DOI: 10.1111/jocs.16883

PMC ID: 9538689

PubMed ID: 36054404

SO-VID: b788e09a-251c-425f-85f9-c89410bb3633

License:

This article is being made freely available through PubMed Central as part of the COVID-19 public health emergency response. It can be used for unrestricted research re-use and analysis in any form or by any means with acknowledgement of the original source, for the duration of the public health emergency.

History

Date revision received : 18 July 2022

Date received : 12 June 2022

Date accepted : 21 July 2022

Page count

Figures: 0, Tables: 1, Pages: 5, Words: 3187

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cover-date November 2022

details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:6.2.0 mode:remove_FC converted:07.10.2022

Retrospective record review on timing of COVID‐19 vaccination and cardiac surgery

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Background

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Conclusions

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Novel Coronavirus Disease COVID-19

Most cited references 15

Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine

Effectiveness of an Inactivated SARS-CoV-2 Vaccine in Chile

Risks of myocarditis, pericarditis, and cardiac arrhythmias associated with COVID-19 vaccination or SARS-CoV-2 infection

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