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1.
BMC Cardiovasc Disord ; 21(1): 434, 2021 09 14.
Article in English | MEDLINE | ID: covidwho-1413998

ABSTRACT

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.


Subject(s)
Aortic Valve/surgery , COVID-19 , Cardiac Surgical Procedures/trends , Heart Valve Diseases/surgery , Outcome and Process Assessment, Health Care/trends , Practice Patterns, Physicians'/trends , Surgeons/trends , Aged , Aged, 80 and over , Cardiac Surgical Procedures/adverse effects , Cardiac Surgical Procedures/mortality , Databases, Factual , Elective Surgical Procedures/trends , Female , Heart Valve Diseases/mortality , Humans , London , Male , Middle Aged , Patient Safety , Postoperative Complications/etiology , Retrospective Studies , Risk Assessment , Risk Factors , Time Factors , Treatment Outcome
2.
BMC Cardiovasc Disord ; 21(1): 434, 2021 09 14.
Article in English | MEDLINE | ID: covidwho-1406707

ABSTRACT

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.


Subject(s)
Aortic Valve/surgery , COVID-19 , Cardiac Surgical Procedures/trends , Heart Valve Diseases/surgery , Outcome and Process Assessment, Health Care/trends , Practice Patterns, Physicians'/trends , Surgeons/trends , Aged , Aged, 80 and over , Cardiac Surgical Procedures/adverse effects , Cardiac Surgical Procedures/mortality , Databases, Factual , Elective Surgical Procedures/trends , Female , Heart Valve Diseases/mortality , Humans , London , Male , Middle Aged , Patient Safety , Postoperative Complications/etiology , Retrospective Studies , Risk Assessment , Risk Factors , Time Factors , Treatment Outcome
3.
Eur J Cardiothorac Surg ; 58(6): 1254-1260, 2020 12 01.
Article in English | MEDLINE | ID: covidwho-1060127

ABSTRACT

OBJECTIVES: Italy has been one of the countries most severely affected by the coronavirus disease 2019 (COVID-19). The Italian government was forced to introduce quarantine measures quickly, and all elective health services were stopped or postponed. This emergency has dramatically changed the management of paediatric and adult patients with congenital heart disease. We analysed data from 14 Italian congenital cardiac surgery centres during lockdown, focusing on the impact of the pandemic on surgical activity, patients and healthcare providers and resource allocation. METHODS: Fourteen centres participated in this study. The period analysed was from 9 March to 4 May. We collected data on the involvement of the hospitals in the treatment of patients with COVID-19 and on limitations on regular activity and on the contagion among patients and healthcare providers. RESULTS: Four hospitals (29%) remained COVID-19 free, whereas 10 had a 39% reduction in the number of beds for surgical patients, especially in the northern area. Two hundred sixty-three surgical procedures were performed: 20% elective, 62% urgent, 10% emergency and 3% life-saving. Hospital mortality was 0.4%. Compared to 2019, the reduction in surgical activity was 52%. No patients operated on had positive test results before surgery for severe acute respiratory syndrome coronavirus 2, the virus responsible for COVID-19. Three patients were infected during the postoperative period. Twenty-nine nurses and 12 doctors were infected. Overall, 80% of our infected healthcare providers were in northern centres. CONCLUSIONS: Our study shows that the pandemic had a different impact on the various Italian congenital cardiac surgery centres based on the different patterns of spread of the virus across the country. During the lockdown, the system was able to satisfy all emergency clinical needs with excellent results.


Subject(s)
COVID-19/prevention & control , Cardiac Surgical Procedures/trends , Health Care Rationing/trends , Health Services Accessibility/trends , Heart Defects, Congenital/surgery , COVID-19/epidemiology , Cross Infection/epidemiology , Cross Infection/prevention & control , Elective Surgical Procedures/trends , Emergencies , Health Care Rationing/methods , Health Care Rationing/organization & administration , Health Care Surveys , Health Policy , Health Services Accessibility/organization & administration , Humans , Infection Control/methods , Italy/epidemiology , Occupational Diseases/epidemiology , Occupational Diseases/prevention & control , Pandemics , Postoperative Complications/epidemiology , Postoperative Complications/prevention & control , Quarantine
4.
Best Pract Res Clin Anaesthesiol ; 35(3): 321-332, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1039303

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic has potentiated the need for implementation of strict safety measures in the medical care of surgical patients - and especially in cardiac surgery patients, who are at a higher risk of COVID-19-associated morbidity and mortality. Such measures not only require minimization of patients' exposure to COVID-19 but also careful balancing of the risks of postponing nonemergent surgical procedures and providing appropriate and timely surgical care. We provide an overview of current evidence for preoperative strategies used in cardiac surgery patients, including risk stratification, telemedicine, logistical challenges during inpatient care, appropriate screening capacity, and decision-making on when to safely operate on COVID-19 patients. Further, we focus on perioperative measures such as safe operating room management and address the dilemma over when to perform cardiovascular surgical procedures in patients at risk.


Subject(s)
COVID-19/prevention & control , Cardiac Surgical Procedures/standards , Patient Safety/standards , Perioperative Care/standards , COVID-19/epidemiology , COVID-19/surgery , Cardiac Surgical Procedures/trends , Humans , Pandemics/prevention & control , Perioperative Care/trends , Risk Factors
5.
Ir J Med Sci ; 190(1): 13-17, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-630922

ABSTRACT

BACKGROUND: Irish health services have been repurposed in response to the COVID-19 pandemic. Critical care services have been re-focused on the management of COVID-19 patients. This presents a major challenge for specialities such as cardiothoracic surgery that are reliant on intensive care unit (ICU) resources. AIM: The aim of this study was to evaluate the impact of the COVID-19 pandemic on activity at the cardiothoracic surgical care at the National Cardiothoracic Surgery and Transplant Centre. METHODS: A comparison was performed of cardiac surgery and transplant caseload for the first 4 months of 2019 and 2020 using data collected prospectively on a customised digital database. RESULTS: Cardiac surgery activity fell over the study period but was most impacted in March and April 2020. Operative activity fell to 49% of the previous years' activity for March and April 2020. Surgical acuity changed with 61% of all cases performed as inpatient transfers after cardiology admission in contrast with a 40% rate in 2019. Valve surgery continued at 89% of the expected rate; coronary artery bypass surgery was performed at 61% of the expected rate and major aortic surgery at 22%. Adult congenital heart cases were not performed in March or April 2020. One heart and one lung transplant were performed in this period. CONCLUSIONS: In March and April of 2020, the spread of COVID-19 and the resultant focus on its management resulted in a reduction in cardiothoracic surgery service delivery.


Subject(s)
COVID-19 , Cardiac Surgical Procedures/trends , Heart Transplantation/trends , Adult , Aged , Aged, 80 and over , Cardiac Valve Annuloplasty/trends , Cardiology , Coronary Artery Bypass/trends , Female , Heart Valve Prosthesis Implantation/trends , Heart-Lung Transplantation/trends , Hospitalization/statistics & numerical data , Humans , Intensive Care Units/supply & distribution , Ireland , Male , Middle Aged , Pandemics , Patient Acuity , Retrospective Studies , SARS-CoV-2 , Young Adult
6.
J Thorac Cardiovasc Surg ; 162(3): 893-903.e4, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-704188

ABSTRACT

OBJECTIVE: The coronavirus disease 2019 (COVID-19) pandemic has resulted in an increase in hospital resource utilization and the need to defer nonurgent cardiac surgery procedures. The present study aims to report the regional variations of North American adult cardiac surgical case volume and case mix through the first wave of the COVID-19 pandemic. METHODS: A survey was sent to recruit participating adult cardiac surgery centers in North America. Data in regard to changes in institutional and regional cardiac surgical case volume and mix were analyzed. RESULTS: Our study comprises 67 adult cardiac surgery institutions with diverse geographic distribution across North America, representing annualized case volumes of 60,452 in 2019. Nonurgent surgery was stopped during the month of March 2020 in the majority of centers (96%), resulting in a decline to 45% of baseline with significant regional variation. Hospitals with a high burden of hospitalized patients with COVID-19 demonstrated similar trends of decline in total volume as centers in low burden areas. As a proportion of total surgical volume, there was a relative increase of coronary artery bypass grafting surgery (high +7.2% vs low +4.2%, P = .550), extracorporeal membrane oxygenation (high +2.5% vs low 0.4%, P = .328), and heart transplantation (high +2.7% vs low 0.4%, P = .090), and decline in valvular cases (high -7.6% vs low -2.6%, P = .195). CONCLUSIONS: The present study demonstrates the impact of COVID-19 on North American cardiac surgery institutions as well as helps associate region and COVID-19 burden with the impact on cardiac surgery volumes and case mix.


Subject(s)
COVID-19 , Cardiac Surgical Procedures/trends , Healthcare Disparities/trends , Practice Patterns, Physicians'/trends , Regional Health Planning/trends , Surgeons/trends , Elective Surgical Procedures/trends , Health Care Surveys , Health Services Needs and Demand/trends , Humans , Needs Assessment/trends , North America , Time Factors
8.
J Thorac Cardiovasc Surg ; 160(4): 937-947.e2, 2020 10.
Article in English | MEDLINE | ID: covidwho-649605

ABSTRACT

BACKGROUND: The onset of the coronavirus disease 2019 (COVID-19) pandemic has forced our cardiac surgery program and hospital to enact drastic measures that has forced us to change how we care for cardiac surgery patients, assist with COVID-19 care, and enable support for the hospital in terms of physical resources, providers, and resident training. METHODS: In this review, we review the cardiovascular manifestations of COVID-19 and describe our system-wide adaptations to the pandemic, including the use of telemedicine, how a severe reduction in operative volume affected our program, the process of redeployment of staff, repurposing of residents into specific task teams, the creation of operation room intensive care units, and the challenges that we faced in this process. RESULTS: We offer a revised set of definitions of surgical priority during this pandemic and how this was applied to our system, followed by specific considerations in coronary/valve, aortic, heart failure and transplant surgery. Finally, we outline a path forward for cardiac surgery for the near future. CONCLUSIONS: We recognize that individual programs around the world will eventually face COVID-19 with varying levels of infection burden and different resources, and we hope this document can assist programs to plan for the future.


Subject(s)
Academic Medical Centers/organization & administration , Betacoronavirus , Cardiac Surgical Procedures , Coronavirus Infections , Health Care Rationing , Health Services Accessibility/organization & administration , Pandemics , Perioperative Care/methods , Pneumonia, Viral , Adult , Betacoronavirus/isolation & purification , COVID-19 , Cardiac Surgical Procedures/trends , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/therapy , Cardiovascular Diseases/virology , Coronavirus Infections/complications , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Female , Health Care Rationing/methods , Health Care Rationing/organization & administration , Humans , Infection Control/methods , Infection Control/organization & administration , Intensive Care Units/organization & administration , Male , Middle Aged , New York City/epidemiology , Operating Rooms/organization & administration , Patient Care Team/organization & administration , Personnel Staffing and Scheduling/organization & administration , Pneumonia, Viral/complications , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Pneumonia, Viral/therapy , SARS-CoV-2 , Telemedicine/methods , Telemedicine/organization & administration
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