Cardiothoracic surgery during the Covid‐19 pandemic: Perioperative care, safety, and surgical results

Abstract

Background Covid‐19 was declared a pandemic by the World Health Organization (WHO) on 11 March 2020. Responses to this crisis integrated resource allocation for the increased amount of infected patients while maintaining an adequate response to other severe and life‐threatening diseases. Though cardiothoracic patients are at high risk for Covid‐19 severe illness, postponing surgeries would translate to increased mortality and morbidity. We reviewed our practice during the initial time of the pandemic, with emphasis on safety protocols. Methods From 11 March to 15 May 2020, 148 patients underwent surgery at the Department of Cardiothoracic Surgery of Centro Hospitalar Universitário de São João. The clinical characteristics of the patients were retrospectively registered, along with novel containment and infection prevention measures targeting the new coronavirus. Results The majority of adult cardiac patients were operated on an emergency basis. Hospital mortality was 1.9% (n = 2 patients). Most adult thoracic patients were admitted from home, with a diagnosis of neoplastic disease in 60% of patients. Hospital mortality was 3.3% (1 patient). Fifteen children underwent cardiothoracic surgery. There was no mortality. The infection prevention procedures applied, totally excluded the transmission of Covid‐19 in the department. Conclusion While guaranteeing a prompt response to emergent, urgent, and high priority cases, novel safety measures in individual protection, patients circuits, and preoperative diagnoses of symptomatic and asymptomatic infection were adopted. The surgical results corroborate that it was safe to undergo cardiothoracic surgery during the initial time of the Covid‐19 pandemic. The new policies will be maintained while the virus stays in the community.

Gore Cardioform ASD device thrombus weeks after COVID‐19 infection

“…A 4-month-old baby with a cardiac teratoma was reported to undergo heart surgery 2 weeks after testing positive for COVID-19 with no complications. 10 Berkhordari et al reported that 21 out of 25 patients with COVID-19 who underwent heart surgery, mainly coronary artery bypass grafting, had smooth respiratory outcomes. 11 However, neither of these procedures required leaving a foreign body in the blood stream as with our patient.…”

“…Limited information has been reported regarding patients undergoing necessary or urgent procedures in the setting of a recent COVID‐19 infection. A 4‐month‐old baby with a cardiac teratoma was reported to undergo heart surgery 2 weeks after testing positive for COVID‐19 with no complications 10 . Berkhordari et al reported that 21 out of 25 patients with COVID‐19 who underwent heart surgery, mainly coronary artery bypass grafting, had smooth respiratory outcomes 11 .…”

Surgical complications in COVID-19 patients in the setting of moderate to severe disease

“…The research article analyses of surgical outcomes allow evaluating the clinical outcomes of patients undergoing urgent or serious surgeries during the COVID-19 pandemic. It was established that the average duration of hospitalization among surgical COVID-19 patients was 10.55 d[ 24 , 25 ]. Once again, the main question in this pandemic situation remains the surgical outcomes in patients with COVID-19 infection[ 26 ].…”

Impact of COVID-19 in the Perioperative Period of Cardiovascular Surgery

“…In addition to this finding, the prevalence of acute renal failure is highlighted, as well as the longer hospital stay between the groups. The changes and protocols initiated by several surgical services for the care of COVID-19 patients were important in the pandemic, as described by Casanova et al [ 2 ] , with the objective of reducing the spreading of the infection and its inherent complications.…”