Early outcomes and complications following cardiac surgery in patients testing positive for coronavirus disease 2019: An international cohort study (original) (raw)
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The Journal of Thoracic and Cardiovascular Surgery, 2021
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JTCVS Open
Objective: In the United Kingdom, the coronavirus disease 2019 (COVID-19) pandemic has led to the cessation of elective surgery. However, there remains a need to provide urgent and emergency cardiac and thoracic surgery as well as to continue time-critical thoracic cancer surgery. This study describes our early experience of implementing a protocol to safely deliver major cardiac and thoracic surgery in the midst of the pandemic. Methods: Data on all patients undergoing cardiothoracic surgery at a single tertiary referral center in London were prospectively collated during the first 7 weeks of lockdown in the United Kingdom. A comprehensive protocol was implemented to maintain a COVID-19-free environment including the preoperative screening of all patients, the use of full personal protective equipment in areas with aerosol-generating procedures, and separate treatment pathways for patients with and without the virus. Results: A total of 156 patients underwent major cardiac and thoracic surgery over the study period. Operative mortality was 9% in the cardiac patients and 1.4% in thoracic patients. The preoperative COVID-19 protocol implemented resulted in 18 patients testing positive for COVID-19 infection and 13 patients having their surgery delayed. No patients who were negative for COVID-19 infection on preoperative screening tested positive postoperatively. However, 1 thoracic patient tested positive on intraoperative bronchoalveolar lavage. Conclusions: Our early experience demonstrates that it is possible to perform major cardiac and thoracic surgery with low operative mortality and zero development of postoperative COVID-19 infection.
IMPACTS OF THE COVID-19 PANDEMIC ON PERFORMING CARDIOVASCULAR SURGICAL PROCEDURES: WHAT WERE THE ALTERNATIVES TO MINIMIZE THE DAMAGE? (Atena Editora), 2023
This article aims to analyze the implications of the Covid-19 pandemic in carrying out cardiovascular surgical procedures and what alternatives were used by Health Systems to overcome the difficulties encountered. This is an integrative literature review, based on articles found in the MedLine database, through a pre-selection, using the descriptors “Cardiovascular Surgical Procedures” and “Covid-19”, joined by the Boolean operator. The selection of articles was based on a scientific question prepared by the PICO strategy and inclusion and exclusion criteria. Articles were classified by country of study, type of surgery, level of evidence by classification: Agency for Healthcare Research and Quality and the implications and adaptations to the pandemic. A total of 112 articles were obtained, with 21 articles selected. The United States and United Kingdom prevailed, with a total of 10 articles. The most discussed procedures were heart valve replacement and implantation (23.81%) and congenital heart surgery (14.28%). As impacts of the pandemic were evidenced: the reduction in the number of procedures (85.71%) and the higher mortality (47.62%). As alternatives used to overcome these difficulties, the use of telemedicine (42.86%) and the advance of procedures for patients positive for Covid-19 (38.10%) stand out.
Perioperative management of COVID-19 patients undergoing cardiac surgery with cardiopulmonary bypass
Perfusion
Coronavirus disease 2019 (COVID-19) is a serious health concern which affects all healthcare professionals worldwide. The pandemic puts health services, including cardiac surgery units, under escalating pressure. There are significant challenges caused by this novel virus and ensuing disease that leads to great uncertainty. While it has been advocated to delay elective surgeries, most cardiac surgical patients present in a more urgent manner which elevates the critical nature for intervention, which may make the surgical decision inevitable. To date, no definitive treatments to the pandemic have been promoted. Cardiac surgical centers may experience an increasing number of COVID-19 patients in clinical practice. Preparation for managing these patients will require a change in the current modalities for perioperative care. Therefore, the goal of this report is to share our own experiences, combined with a review of the emerging literature, by highlighting principles for the adult car...
Indian Heart Journal, 2021
Background: The rates of in-hospital mortality following percutaneous interventional procedures (PIP) during the COVID-19 pandemic period compared to the non-pandemic period has not been reported so far. Methods: We retrospectively enrolled all consecutive patients admitted for PIP across five centers from February 2020 to May 2020. Results: A total of 4092 PIP were performed during the reference periods. The total number of procedures dropped from 2380 to 1712 (28.0% reduction). Overall in-hospital mortality increased from 1.1% in 2019, to 2.6% in 2020 (63% relative increase). Conclusion: During the COVID-19 pandemic, in-hospital all-cause mortality significantly increased in patients admitted for cardiological PIP.
Cureus, 2022
Objective To assess the effect of the COVID-19 pandemic on the cardiothoracic and vascular surgery procedures volume at a tertiary care hospital. Materials & Methods This cross-sectional retrospective study was carried out at a tertiary care hospital's Cardiothoracic and Vascular Surgery department. All the four-year surgical procedures data were reviewed from August 2017 to August 2021. After extracting data from the hospital database software, a databank was generated in SPSS version 24.0. Average cases per month were calculated, and the data were stratified into three groups, Pre-COVID, COVID, and Post-COVID. Tables and charts were generated for the representation of data. Results The total number of patients that underwent cardiovascular and thoracic procedures during the years 2017-2021 were 3,624, with male predominance (71.5%). Procedures were divided into Pre-COVID (68.5%), COVID (15.2%) and Post-COVID (16.3%) groups. Coronary Artery Bypass Grafting (CABG) was the most c...
Cardiac surgery practice during the COVID-19 outbreak: a multicentre national survey
European Journal of Cardio-Thoracic Surgery, 2021
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 ...
IACTS guidelines: practice of cardiovascular and thoracic surgery in the COVID-19 era
Indian Journal of Thoracic and Cardiovascular Surgery, 2020
Patients undergoing cardiovascular and thoracic procedures are at an accentuated risk of higher morbidity and mortality, which are a consequence of the proliferative nature of the severe acute respiratory syndrome-corona virus 2 (SARS-CoV-2) on the lung vasculature, which in turn reflects as a cascading effect on the interdependent physiology of the cardiovascular and pulmonary organ systems. These are secondary to systemic inflammatory response syndrome and immunosuppressive responses to surgery and mechanical ventilation. Thus, the need to establish guidelines for the practice of cardiothoracic surgery which is safe for both the patient and the healthcare team presents as a priority, which is the mainstay of this article.