Cardiac surgery during the COVID-19 pandemic: from <i>vita minima</i> to recovery

Smail, Hassiba; Stock, Ulrich A.; Robertis, Fabio De; Bhudia, Sunil; Mittal, Tarun; Mattison, Simon; Petrou, Mario; Hill, J D; Gaer, Jullien

doi:10.1002/bjs.11941

Cited by 3 publications

(9 citation statements)

References 3 publications

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“…Patients are encouraged to self-isolate for 14 days until the date of the procedure; 46 moreover scheduling laboratory tests and imaging close to the date of surgery, along with swabs the day before admission was highly recommended. 44 Other reports focused their attention on perioperative management, supporting the concept that only essential figures should be involved in the operative room. Moreover, a waiting period of 30 min before entrance into the operative room after aerosol generating procedures was strongly recommended.…”

Section: Protection Of Healthcare Personnelmentioning

confidence: 99%

“…42,43 Given the low sensitivity and the interval time to get a result (24-48 h), clinical and exposure history, routine laboratory tests and imaging become essential tools in COVID-19 screening before surgery. 20,28,32,34,44,45 These measures provide more accurate information to delineate the most appropriate intervention and its timing, taking into account resource limitations, risk of perioperative infection and postoperative adverse events, with particular attention to asymptomatic or mild disease. 23,29,34 The need to avoid intrahospital transmission led to some recommendations for preoperative screening.…”

Section: Protection Of Healthcare Personnelmentioning

confidence: 99%

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The day after tomorrow: cardiac surgery and coronavirus disease-2019

Bonalumi

Giambuzzi

Buratto³

et al. 2021

Journal of Cardiovascular Medicine

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The impact of the coronavirus disease-2019 (COVID-19) pandemic forced the governments worldwide to deal with an unprecedented health crisis. The aim of this review is to summarize what happened to cardiac surgery worldwide during the first wave of this pandemic. A literature search was performed to extrapolate key concepts regarding guidelines and reorganization of cardiac surgery wards during COVID-19. Supporting literature was also included to discuss the hot topics related to COVID-19 and cardiac surgery. Hence, both official documents from national scientific societies and single-or multiple-center experiences during the pandemics are reviewed and discussed. In Italy, the first western country hit by the pandemic, two different models were proposed to cope with the need for ICU/ward beds and to reallocate cardiac surgical services: Hub-and-Spoke system ('Hubs', dedicated to perform urgent and nondeferrable surgery, and 'Spokes', turned into COVID centers) and/or a progressive reduction in surgical activity. Worldwide, several guidelines/consensus statements were published, suggesting how to deal with the outbreak. Two different approaches for stratifying surgical indications were proposed: dynamic, based on the number of hospitalized COVID-19 patients; static, based only on the severity of the cardiovascular disease. Moreover, the importance of personal protective equipment was stressed. Several measures should have been adopted to deal with an unprecedented need for healthcare resources allocation to care for COVID-19 patients, putting the healthcare systems under serious stress. Cardiac surgery has, as have most surgical activities, been asked to reduce its own activity, giving priority to emergency and nondeferrable cases.

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Section: Protection Of Healthcare Personnelmentioning

confidence: 99%

Section: Protection Of Healthcare Personnelmentioning

confidence: 99%

The day after tomorrow: cardiac surgery and coronavirus disease-2019

Bonalumi

Giambuzzi

Buratto³

et al. 2021

Journal of Cardiovascular Medicine

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show abstract

“…After a phase of justifiable caution and falling demand, we have developed a system for the safe conduct of cardiac surgery with specific strategies for the stratification of urgent referrals, waiting list management and infection control 1 that have enabled our non-COVID work to continue at a time when the demand for some of our other specialist services has been unprecedented. 8…”

Section: Discussionmentioning

confidence: 99%

“…We have previously reported our experience of maintaining a regional cardiac surgical service during the first surge of the COVID-19 pandemic in the UK. 1 At the time of writing, the number of confirmed cases of COVID-19 worldwide exceeds 270 million, while in the UK the number of confirmed cases has surpassed 11 million and there have been more than 140,000 deaths. 2 On 29 April 2020, Sir Simon Stevens, the Chief Executive of the National Health Service (NHS), wrote to all NHS hospital CEO's setting out requirements for managing 'the second phase of the NHS response to the COVID-19 outbreak'.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The results of cardiac surgery during the COVID-19 pandemic compared with previous years: a propensity weighted study of outcomes at six months

et al. 2022

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Objectives In addition to excess mortality due to COVID-19, the pandemic has been characterised by excess mortality due to non-COVID diagnoses and consistent reports of patients delaying seeking medical treatment. This study seeks to compare the outcomes of cardiac surgery during and before the COVID-19 pandemic. Design Our institutional database was interrogated retrospectively to identify all patients undergoing one of three index procedures during the first six months of the pandemic and the corresponding epochs of the previous five years. Setting A regional cardiothoracic centre. Participants All patients undergoing surgery during weeks #13-37, 2015-2020. Main outcome measures Propensity score weighted analysis was employed to compare the incidence of major complications (stroke, renal failure, re-ventilation), 30-day mortality, six month survival and length of hospital stay between the two groups. Results There was no difference in 30-day mortality (HR = 0.76 [95% CI 0.27-2.20], p = 0.6211), 6-month survival (HR = 0.94 [95% CI 0.44-2.01], p = 0.8809) and duration of stay (SHR = 1.00 (95% CI 0.90-1.12), p = 0.959) between the two eras. There were no differences in the incidence of major complications (weighted chi-square test: renal failure: p = 0.923, stroke: p = 0.991, new respiratory failure: p = 0.856). Conclusions Cardiac surgery is as safe now as in the previous five years. Concerns over the transmission of COVID-19 in hospital are understandable but patients should be encouraged not to delay seeking medical attention. All involved in healthcare and the wider public should be reassured by these findings.

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Multidisciplinary paper on patient blood management in cardiothoracic surgery in the UK: perspectives on practice during COVID-19

Al‐Attar

Gaer

Giordano

et al. 2023

J Cardiothorac Surg

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The coronavirus (COVID-19) pandemic disrupted all surgical specialties significantly and exerted additional pressures on the overburdened United Kingdom (UK) National Health Service. Healthcare professionals in the UK have had to adapt their practice. In particular, surgeons have faced organisational and technical challenges treating patients who carried higher risks, were more urgent and could not wait for prehabilitation or optimisation before their intervention. Furthermore, there were implications for blood transfusion with uncertain patterns of demand, reductions in donations and loss of crucial staff because of sickness and public health restrictions. Previous guidelines have attempted to address the control of bleeding and its consequences after cardiothoracic surgery, but there have been no targeted recommendations in light of the recent COVID-19 challenges. In this context, and with a focus on the perioperative period, an expert multidisciplinary Task Force reviewed the impact of bleeding in cardiothoracic surgery, explored different aspects of patient blood management with a focus on the use of haemostats as adjuncts to conventional surgical techniques and proposed best practice recommendations in the UK.

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Cardiac surgery during the COVID-19 pandemic: from vita minima to recovery

Cited by 3 publications

References 3 publications

The day after tomorrow: cardiac surgery and coronavirus disease-2019

The day after tomorrow: cardiac surgery and coronavirus disease-2019

The results of cardiac surgery during the COVID-19 pandemic compared with previous years: a propensity weighted study of outcomes at six months

Multidisciplinary paper on patient blood management in cardiothoracic surgery in the UK: perspectives on practice during COVID-19

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