Elective Cardiopulmonary Bypass (CPB) Surgery After COVID-19: Vasoactive Needs and Early Complications—A Prospective Study

Background/Objectives: Whether a remote history of SARS-CoV-2 infection independently affects early haemodynamic stability after elective cardiopulmonary bypass (CPB) remains uncertain. We evaluated whether prior COVID-19 (>7 weeks before surgery) was associated with postoperative vasopressor requirements or early complications in adults undergoing elective CPB. Methods: We conducted a single-centre prospective cohort study including adults (≥18 years) scheduled for elective on-pump coronary, valve, or combined cardiac surgery between 1 August 2022 and 30 October 2023. Patients undergoing emergency procedures or surgery < 7 weeks after infection were excluded. The exposure was a documented history of COVID-19 for >7 weeks preoperatively. The primary outcome was postoperative vasopressor use within 24 h of ICU admission; secondary outcomes included inotrope use, arrhythmias, acute cardiac or respiratory failure, pneumonia, acute kidney injury (KDIGO), delirium, stroke, length of stay, and mortality. Multivariable logistic regression adjusted for age, CPB duration, obesity, anaemia, chronic kidney disease, sex, EuroSCORE I, left ventricular ejection fraction, and procedure type. Results: Of 351 screened patients, 280 elective CPB cases were analyzed; 101 (36.1%) had prior COVID-19. Vasopressor use occurred in 151/280 (53.9%) patients, with no difference between COVID and non-COVID groups (53.5% vs. 54.2%; p = 1.00). Prior COVID-19 was not associated with vasopressor requirement (adjusted OR 0.94, 95% CI 0.56–1.59). Independent predictors were longer CPB duration (aOR 2.80 per hour; p < 0.001) and older age (aOR 1.028 per year; p = 0.02). Secondary outcomes, including organ dysfunction and mortality, did not differ between groups. Conclusions: In adults undergoing elective CPB ≥ 7 weeks after SARS-CoV-2 infection, prior COVID-19 did not increase early vasopressor needs or short-term postoperative complications. Haemodynamic requirements were primarily driven by CPB duration and age. Further research using dose-standardized vasoactive metrics and formal COVID-19 severity stratification is warranted.