JTCVS Open (Dec 2020)

Cardiothoracic surgery in the midst of a pandemic: Operative outcomes and maintaining a coronavirus disease 2019 (COVID-19)–free environmentCentral MessagePerspective

  • Damian Balmforth, FRCS(CTh), PhD,
  • Martin T. Yates, MBBS, MD,
  • Kelvin Lau, FRCS (CTh), PhD,
  • Azhar Hussain, MBBS,
  • Ana Lopez-Marco, FRCS (CTh), PhD,
  • Stephen Edmondson, FRCS, (CTh),
  • Aung Oo, FRCS (CTh), PhD,
  • Rakesh Uppal, FRCS (CTh),
  • A. Sepehripour,
  • K. Lall,
  • N. Roberts,
  • C. Di Salvo,
  • S. Kolvekar,
  • K. Wong,
  • S. Ambekar,
  • A. Sheikh,
  • B. Adams,
  • J. Yap,
  • D. Lawrence,
  • W. Awad,
  • A. Shipolini,
  • C. Rathwell,
  • Mohamed Rahnavardi,
  • Steven Stamenkovic,
  • David Waller,
  • Henrietta Wilson,
  • May Al-Sahaf

Journal volume & issue
Vol. 4
pp. 107 – 114

Abstract

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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.

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