Adult cardiac surgery in Trinidad and Tobago during the COVID‐19 pandemic: Lessons from a developing country

Abstract

Background and Aim The coronavirus disease 2019 (COVID‐19) pandemic has seen the cancellation of elective cardiac surgeries worldwide. Here we report the experience of a cardiac surgery unit in a developing country in response to the COVID‐19 crisis. Methods From 6th April to 12th June 2020, 58 patients underwent urgent or emergency cardiac surgery. Data was reviewed from a prospectively entered unit‐maintained cardiac surgery database. To ensure safe delivery of care to patients, a series of strict measures were implemented which included: a parallel healthcare system maintaining a COVID‐19 cold site, social isolation of patients for one to 2 weeks before surgery, polymerase chain reaction testing for COVID‐19, 72 hours before surgery, discrete staff assigned only to cardiac surgical cases socially isolated for 2 weeks as necessary. Results The mean age at surgery was 59.7 ± 11 years and 41 (70.7%) were male. Fifty‐two patients were hypertensive (90%), and 32 were diabetic (55.2%). There were three emergency type A aortic dissections. Forty‐seven patients underwent coronary artery bypass graft surgery with all but three performed off‐pump. Fourteen cases required blood product transfusion. One patient had postoperative pneumonia associated with chronic obstructive pulmonary disease. The median length of stay was 5.7 ± 1.8 days. All patients were discharged home after rehabilitation. There were no cases of COVID‐19 infection among healthcare workers during the study period. Conclusion These strategies allowed us to maintain a service for urgent and emergency procedures and may prove useful for larger countries when there is decrease in COVID‐19 cases and planning for the restart of elective cardiac surgery.

COVID‐19 and cardiac surgery: Do outcomes differ?

“…Three of those patients were acute aortic dissections while the rest were combination of urgent coronary artery bypass grafting and/or symptomatic aortic valve replacements. Patient selection was identified through multidisciplinary team (MDT) discussions and surgery planned accordingly 9 . Operations on these patients was carried out using personal protective equipment (PPE) and minimising theatre staff to the lowest safe possible numbers.…”

“…Patient selection was identified through multidisciplinary team (MDT) discussions and surgery planned accordingly. 9 Operations on these patients was carried out using personal protective equipment (PPE) and minimising theatre staff to the lowest safe possible numbers. Their experience reflects how cardiac surgery has been adapted safely in the high-income developing country of Trinidad and Tobago (T&T) during these unprecedented times.…”

“…Their experience reflects how cardiac surgery has been adapted safely in the high-income developing country of Trinidad and Tobago (T&T) during these unprecedented times. 9 While T&T have the second highest income per capita in the region, national health indicators significantly lag behind economic growth and substantial pockets of poverty remain. 10 Despite its small population of 1.40 million, T&T has the world's 34th highest population density, similar to that of the United States of America.…”

“…11,12 These changes may subsequently be compared with low-and middle-income countries (LMICs), in addition to their developed counterparts. Like many countries across the globe, the burden on healthcare services resulted in the suspension of all elective surgeries in T&T. 9,13 Their deferral proves to be an important step in enabling the reallocation of limited staff to intensive care units (ICUs) and rationing the use of supplies including PPE and blood products. The introduction of aggressive healthcare policies was deemed essential to reduce the risk of transmission and likelihood of patients acquiring nosocomial COVID-19 infection.…”

“…preoperative RT-PCR. 9 Given that 43% to 60% of patients with COVID-19 are thought to be asymptomatic, this has implications for risk stratification and preventing disease spread. 3,23,24 Therefore, testing for SARS-CoV-2 in patients undergoing cardiac surgery is important as many of such patients are asymptomatic and may have subclinical infections which could have significant impact on perioperative outcomes.…”