The ongoing impact of COVID-19 on adult cardiac surgery and suggestions for safe continuation throughout the pandemic: a review of expert opinions

Abstract

Objectives: To establish the impact of the COVID-19 pandemic on adult cardiac surgery by reviewing current data and use this to establish methods for safely continuing to carry out surgery. Methods: Conduction of a literature search via PubMed using the search terms: ‘(adult cardiac OR cardiothoracic OR surgery OR minimally invasive OR sternotomy OR hemi-sternotomy OR aortic valve OR mitral valve OR elective OR emergency) AND (COVID-19 or coronavirus OR SARS-CoV-2 OR 2019-nCoV OR 2019 novel coronavirus OR pandemic)’. Thirty-two articles were selected. Results: Cardiac surgery patients have an increased risk of complications from COVID-19 and require vital finite resources such as intensive care beds, also required by COVID-19 patients. Thus reducing their admission and potential hospital-acquired infection with COVID-19 is paramount. During the peak, only emergencies such as acute aortic dissections were treated, triaging patients according to surgical priority and cancelling all elective procedures. Screening and 2-week quarantine prior to admission were essential changes, alongside additional levels of PPE. Focus was on reducing length of stay and switching to day-cases to reduce post-operative transmission risk, whilst several hospitals adopted ‘hot’ and ‘cold’ operating theatres for covid-confirmed and covid-negative patients. Conclusions: This paper suggests a ‘CARDIO’ approach for reintroducing elective procedures: ‘Care, Assess, Re-Evaluate, Develop, Implement, Overcome’; prioritising the mental and physical health of the workforce, learning from and sharing experiences and objectively prioritising patients to improve case load.

Herzchirurgie während der COVID-19-Pandemie

“…As already described, most intensive care units were very soon occupied by COVID patients. This was especially true for most heart surgical intensive care units with relevant experience in and wide-ranging equipment for cardiopulmonary critical care, such as oxygenators and ventilators, both scarce items during the initial waves of the pandemic [ 5 , 6 ].…”

“…In some instances, even transplantations had to be delayed [ 8 ]. Most centers defined their own criteria for emergent, urgent, and elective cases with respect to the given local limitations and risks [ 6 ]. Telemedical surveillance was implemented for patients on the waiting list, and patients were referred to other hospitals across borders.…”

“…Telemedical surveillance was implemented for patients on the waiting list, and patients were referred to other hospitals across borders. With the availability of vaccines and decreasing numbers of hospitalizations related to COVID infections, heart surgery programs were slowly rebooted; however, most of them are not back to normal to date [ 6 , 9 ]. Whereas the numbers of infected patients in intensive care units have indeed decreased substantially and are no longer a limiting problem in most hospitals, doctors and even more so nurses have left their jobs after the pandemic.…”