Prioritizing cardiovascular surgical care in COVID-19 pandemic: Shall we operate or defer?

The day after tomorrow: cardiac surgery and coronavirus disease-2019

The impact of the coronavirus disease-2019 (COVID-19) pandemic forced the governments worldwide to deal with an unprecedented health crisis. The aim of this review is to summarize what happened to cardiac surgery worldwide during the first wave of this pandemic. A literature search was performed to extrapolate key concepts regarding guidelines and reorganization of cardiac surgery wards during COVID-19. Supporting literature was also included to discuss the hot topics related to COVID-19 and cardiac surgery. Hence, both official documents from national scientific societies and single- or multiple-center experiences during the pandemics are reviewed and discussed. In Italy, the first western country hit by the pandemic, two different models were proposed to cope with the need for ICU/ward beds and to reallocate cardiac surgical services: Hub-and-Spoke system ('Hubs', dedicated to perform urgent and nondeferrable surgery, and 'Spokes', turned into COVID centers) and/or a progressive reduction in surgical activity. Worldwide, several guidelines/consensus statements were published, suggesting how to deal with the outbreak. Two different approaches for stratifying surgical indications were proposed: dynamic, based on the number of hospitalized COVID-19 patients; static, based only on the severity of the cardiovascular disease. Moreover, the importance of personal protective equipment was stressed. Several measures should have been adopted to deal with an unprecedented need for healthcare resources allocation to care for COVID-19 patients, putting the healthcare systems under serious stress. Cardiac surgery has, as have most surgical activities, been asked to reduce its own activity, giving priority to emergency and nondeferrable cases.

Prioritizing cardiovascular surgical care in COVID-19 pandemic: Shall we operate or defer?

BACKGROUND

The coronavirus disease (COVID-19) has affected a large population across the world. Patients with cardiovascular disease have increased morbidity and mortality due to coronavirus disease. The burden over the health care system has to be reduced in this global pandemic to provide optimal care of patients with COVID-19, as well not compromising those who are in need of emergent cardiovascular care.

METHODS

There is a very limited data published defining which cardiovascular procedures are to be performed or to be deferred in the COVID-19 pandemic. In this article, we have reviewed a few published guidelines regarding cardiovascular surgery in COVID-19 pandemics.

CONCLUSION

After reviewing a few available guidelines regarding cardiovascular surgery in COVID-19, we conclude to perform only those surgeries which cannot be deferred to a certain period of time, to reduce the burden of the health care system of the country, provide optimal care to patients with COVID-19, and to protect health care workers and cardiovascular patients from COVID-19.