The impact of COVID-19 pandemic on adult cardiac surgery procedures

Lazaros, George; Oikonomou, Evangelos; Theofilis, Panagiotis; Theodoropoulou, Alexandra; Triantafyllou, Konstantinos; Charitos, Christos; Charalambous, Georgios; Papanikolaou, Aggelos; Gastouniotis, Ioannis; Siasos, Gerasimos; Vlachopoulos, Charalambos; Tousoulis, Dimitris

doi:10.1016/j.hjc.2020.07.001

Cited by 20 publications

(17 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…An exploratory single unit level analysis was conducted to examine the impact of COVID-19 on the provision of cardiac surgery in a large Australian tertiary public hospital and nominated COVID centre. The observed reduction in operating capacity was consistent with international experience [2][3][4][5]. Despite a reduction in operating capacity of over 20% during the COVID-19 period our institution did not observe a significant change in the demographic of patients undergoing surgery, the urgency of procedures performed, or the types of procedures performed.…”

Section: Discussionsupporting

confidence: 85%

“…In Lombardy, Italy, 16 of 20 cardiac centres were closed and only the most urgent cases proceeded [2]. In Greece, Lazaros et al reported a 67% reduction in case volume (from 246 to 84) and a doubling in the proportion of urgent procedures (from 15.5% to 32.1%) during the period of reduced operating in 2020 compared to the same period of time in 2019 [3]. Casey et al reported similar findings from Ireland with a 49% reduction in operations performed and an increase in urgent operations from 40% to 61% [4].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The Impact of COVID-19 on the Provision of Adult Cardiac Surgery at a Dedicated COVID Hospital in Australia

McNamara

Robinson

Bannon

2021

Heart, Lung and Circulation

View full text Add to dashboard Cite

Background Internationally, the response to the COVID-19 pandemic has resulted in fewer cardiac surgical procedures being performed and an increase in the proportion of non-elective cases. To date there has been no study examining the impact of COVID-19 on the provision of cardiac surgery in Australia. Aim The aim of this study was to evaluate the impact that the COVID-19 pandemic has had on the provision of cardiac surgery in a single, large major cardiac centre and dedicated COVID-19 hospital. A retrospective cohort study was undertaken utilising prospectively collected data. Methods Prospectively collected patient and operative data was examined to assess whether there was a reduction in the number of cases performed and whether there was a difference in patient demographics, surgical procedures or case urgency. Data was examined from the period of COVID-restrictions in 2020 and compared with data from the same time period in 2019. Results From 3 March 2020 to 30 June 2020, 136 adults underwent cardiac surgery at our institution, representing an overall reduction in operative caseload of 21%. The largest impact was noticed in May and April and coincided with statewide restrictions on elective surgery. Surgical acuity was unchanged with 58% of operations classified as non-elective procedures performed during the index admission. There was a small non-significant increase in the proportion of isolated coronary artery bypass surgery and aortic valve surgeries performed. Conclusion From March to June 2020 our local hospital response to the COVID-19 pandemic resulted in a reduction in cardiac surgery service delivery. No change was seen in the urgency or type of surgeries performed.

show abstract

Section: Discussionsupporting

confidence: 85%

Section: Introductionmentioning

confidence: 99%

The Impact of COVID-19 on the Provision of Adult Cardiac Surgery at a Dedicated COVID Hospital in Australia

McNamara

Robinson

Bannon

2021

Heart, Lung and Circulation

View full text Add to dashboard Cite

show abstract

“…While no other study has looked at this specific cohort, our findings are commensurate with the overall decline in activity observed during the pandemic for all cardiac procedures. 9 , 11 , 14 , 24 , 25 Secondly, we observe significant differences in the choice of revascularisation between the pre‐COVID and COVID periods, with a shift toward greater PCI utilization in the COVID period. This finding was consistent across different age groups.…”

Section: Discussionmentioning

confidence: 75%

Revascularisation strategies in patients with significant left main coronary disease during the COVID‐19 pandemic

Mohamed

Curzen

Belder

et al. 2021

Cathet Cardio Intervent

View full text Add to dashboard Cite

Background There are limited data on the impact of the COVID‐19 pandemic on left main (LM) coronary revascularisation activity, choice of revascularisation strategy, and post‐procedural outcomes. Methods All patients with LM disease (≥50% stenosis) undergoing coronary revascularisation in England between January 1, 2017 and August 19, 2020 were included ( n = 22,235), stratified by time‐period (pre‐COVID: 01/01/2017–29/2/2020; COVID: 1/3/2020–19/8/2020) and revascularisation strategy (percutaneous coronary intervention (PCI) vs. coronary artery bypass grafting (CABG). Logistic regression models were performed to examine odds ratio (OR) of 1) receipt of CABG (vs. PCI) and 2) in‐hospital and 30‐day postprocedural mortality, in the COVID‐19 period (vs. pre‐COVID). Results There was a decline of 1,354 LM revascularisation procedures between March 1, 2020 and July 31, 2020 compared with previous years' (2017–2019) averages (−48.8%). An increased utilization of PCI over CABG was observed in the COVID period (receipt of CABG vs. PCI: OR 0.46 [0.39, 0.53] compared with 2017), consistent across all age groups. No difference in adjusted in‐hospital or 30‐day mortality was observed between pre‐COVID and COVID periods for both PCI (odds ratio (OR): 0.72 [0.51. 1.02] and 0.83 [0.62, 1.11], respectively) and CABG (OR 0.98 [0.45, 2.14] and 1.51 [0.77, 2.98], respectively) groups. Conclusion LM revascularisation activity has significantly declined during the COVID period, with a shift towards PCI as the preferred strategy. Postprocedural mortality within each revascularisation group was similar in the pre‐COVID and COVID periods, reflecting maintenance in quality of outcomes during the pandemic. Future measures are required to safely restore LM revascularisation activity to pre‐COVID levels.

show abstract

“…These effects were enhanced in Mid-Atlantic region, where a decline of 71% was documented [ 17 ]. Even in countries where COVID-19 was initially contained due to strict restrictive measures, valvular heart disease operations were among the most severely affected procedures: 75% reduction in surgical caseload was reported by two large Greece-based centres [ 18 ]. On the other hand, an aortovascular disease centre in the UK managed to maintain its surgical volume during the investigated outbreak period [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

The impact of COVID-19 pandemic on aortic valve surgical service: a single centre experience

Vlastos

Chauhan

Mensah

et al. 2021

BMC Cardiovasc Disord

View full text Add to dashboard Cite

Background The coronavirus-disease 2019 (COVID-19) pandemic imposed an unprecedented burden on the provision of cardiac surgical services. The reallocation of workforce and resources necessitated the postponement of elective operations in this cohort of high-risk patients. We investigated the impact of this outbreak on the aortic valve surgery activity at a single two-site centre in the United Kingdom. Methods Data were extracted from the local surgical database, including the demographics, clinical characteristics, and outcomes of patients operated on from March 2020 to May 2020 with only one of the two sites resuming operative activity and compared with the respective 2019 period. A similar comparison was conducted with the period between June 2020 and August 2020, when operative activity was restored at both institutional sites. The experience of centres world-wide was invoked to assess the efficiency of our services. Results There was an initial 38.2% reduction in the total number of operations with a 70% reduction in elective cases, compared with a 159% increase in urgent and emergency operations. The attendant surgical risk was significantly higher [median Euroscore II was 2.7 [1.9–5.2] in 2020 versus 2.1 [0.9–3.7] in 2019 (p = 0.005)] but neither 30-day survival nor freedom from major post-operative complications (re-sternotomy for bleeding/tamponade, transient ischemic attack/stroke, renal replacement therapy) was compromised (p > 0.05 for all comparisons). Recommencement of activity at both institutional sites conferred a surgical volume within 17% of the pre-COVID-19 era. Conclusions Our institution managed to offer a considerable volume of aortic valve surgical activity over the first COVID-19 outbreak to a cohort of higher-risk patients, without compromising post-operative outcomes. A backlog of elective cases is expected to develop, the accommodation of which after surgical activity normalisation will be crucial to monitor.

show abstract

The impact of COVID-19 pandemic on adult cardiac surgery procedures

Cited by 20 publications

References 6 publications

The Impact of COVID-19 on the Provision of Adult Cardiac Surgery at a Dedicated COVID Hospital in Australia

The Impact of COVID-19 on the Provision of Adult Cardiac Surgery at a Dedicated COVID Hospital in Australia

Revascularisation strategies in patients with significant left main coronary disease during the COVID‐19 pandemic

The impact of COVID-19 pandemic on aortic valve surgical service: a single centre experience

Contact Info

Product

Resources

About