Cardiac surgery practice during the COVID-19 outbreak: a multicentre national survey

Abstract

OBJECTIVES Healthcare systems worldwide have been overburdened by the coronavirus disease 2019 (COVID-19) outbreak. Accordingly, hospitals had to implement strategies to profoundly reshape both non-COVID-19 medical care and surgical activities. Knowledge about the impact of the COVID-19 pandemic on cardiac surgery practice is pivotal. The goal of the present study was to describe the changes in cardiac surgery practices during the health emergency at the national level. METHODS A 26-question web-enabled survey including all adult cardiac surgery units in Italy was conducted to assess how their clinical practice changed during the national lockdown. Data were compared to data from the corresponding period in 2019. RESULTS All but 2 centres (94.9%) adopted specific protocols to screen patients and personnel. A significant reduction in the number of dedicated cardiac intensive care unit beds (−35.4%) and operating rooms (−29.2%), along with healthcare personnel reallocation to COVID departments (nurses −15.4%, anaesthesiologists −7.7%), was noted. Overall adult cardiac surgery volumes were dramatically reduced (1734 procedures vs 3447; P < 0.001), with a significant drop in elective procedures [580 (33.4%) vs 2420 (70.2%)]. CONCLUSIONS This national survey found major changes in cardiac surgery practice as a response to the COVID-19 pandemic. This experience should lead to the development of permanent systems-based plans to face possible future pandemics. These data may effectively help policy decision-making in prioritizing healthcare resource reallocation during the ongoing pandemic and once the healthcare emergency is over.

Bleeding Complications in Patients With Perioperative COVID-19 Infection Undergoing Cardiac Surgery: A Single-Center Matched Case-Control Study

“…In this study all patients underwent CPB and, in contrast to that reported in other studies, 1,5,[7][8][9][10] bleeding was the most frequently encountered complication. The most likely pathophysiological mechanism is, in addition to surgical trauma, CPB-related inflammatory reaction, interstitial edema, heparinization, hemodilution, hemolysis and coagulation factor consumption, which may have contributed to precipitating postoperative hemorrhagic complications (Fig.…”

“…[2][3][4] In addition, in many cardiothoracic surgery centers, a severe reduction of operated cases has been observed. 1,4,[7][8][9][10] COVID-19 syndrome, putatively caused by coronavirus-2, is frequently characterized by acute respiratory failure with radiological signs of interstitial pneumonia, ground glass opacities and/or bilateral patchy shadowing. In some instances, ARDS and shock may also occur.…”

“…11 A few studies investigating the clinical outcomes of COVID-19 patients undergone undergoing surgery, reported increased morbidity and mortality. 1,[8][9][10] In nine COVID-19 patients undergoing cardiac surgery, Yates et al 1 reported a 44% mortality rate mainly due to severe respiratory failure. SARS-CoV-2 is a pleiotropic virus that causes several different clinical syndromes and changes in laboratory parameters, including thrombocytopenia, lymphocytopenia and a prolonged PT.…”

“…[1][2][3][4][5][6][7] In many centers, the number of elective surgical cases decreased and patients undergoing surgery that could no longer be delayed, experienced worse outcomes with increased mortality rate and postoperative complications incidence. 1,5,[7][8][9] Among coronavirus disease patients, the most frequent complications included interstitial pneumonia with respiratory failure and acute respiratory distress syndrome (ARDS), acute renal failure and thromboembolic events. 1,[6][7][8][9][10][11][12][13][14][15] However, during surgery in COVID-19 patients, perioperative bleeding was less observed, and has not been thoroughly investigated.…”

“…1,5,[7][8][9] Among coronavirus disease patients, the most frequent complications included interstitial pneumonia with respiratory failure and acute respiratory distress syndrome (ARDS), acute renal failure and thromboembolic events. 1,[6][7][8][9][10][11][12][13][14][15] However, during surgery in COVID-19 patients, perioperative bleeding was less observed, and has not been thoroughly investigated.…”