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)
Betacoronavirus , Cardiac Surgical Procedures/methods , Cardiovascular Diseases/surgery , Coronavirus Infections/epidemiology , Intensive Care Units/organization & administration , Pandemics , Pneumonia, Viral/epidemiology , Telemedicine/methods , COVID-19 , Cardiovascular Diseases/epidemiology , Comorbidity , Global Health , Humans , SARS-CoV-2ABSTRACT
The COVID-19 pandemic necessitates aggressive infection mitigation strategies to reduce the risk to patients and healthcare providers. This document is intended to provide a framework for the adult cardiac surgeon to consider in this rapidly changing environment. Preoperative, intraoperative, and postoperative detailed protective measures are outlined. These are guidance recommendations during a pandemic surge to be used for all patients while local COVID-19 disease burden remains elevated.
Subject(s)
Betacoronavirus/pathogenicity , Cardiac Surgical Procedures/standards , Coronavirus Infections/prevention & control , Cross Infection/prevention & control , Heart Diseases/surgery , Infection Control/standards , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Infectious Disease Transmission, Professional-to-Patient/prevention & control , Operating Rooms/standards , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Recovery Room/standards , COVID-19 , Cardiac Surgical Procedures/adverse effects , Consensus , Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Coronavirus Infections/virology , Cross Infection/epidemiology , Cross Infection/transmission , Cross Infection/virology , Heart Diseases/epidemiology , Humans , Occupational Health/standards , Patient Safety/standards , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission , Pneumonia, Viral/virology , Risk Assessment , Risk Factors , SARS-CoV-2 , VirulenceSubject(s)
Betacoronavirus , Coronary Artery Bypass , Coronavirus Infections/etiology , Pneumonia, Viral/etiology , Postoperative Complications , Betacoronavirus/isolation & purification , COVID-19 , COVID-19 Testing , Clinical Laboratory Techniques , Coronavirus Infections/diagnosis , Coronavirus Infections/therapy , Fatal Outcome , Humans , Male , Middle Aged , Pandemics , Perioperative Care , Pneumonia, Viral/diagnosis , Pneumonia, Viral/therapy , Postoperative Complications/diagnosis , Postoperative Complications/therapy , SARS-CoV-2ABSTRACT
Patients with structural heart disease are at increased risk of adverse outcomes from the coronavirus disease-2019 (COVID-19) due to advanced age and comorbidity. In the midst of a global pandemic of a novel infectious disease, reality-based considerations comprise an important starting point for formulating clinical management pathways. The aims of these "crisis-driven" recommendations are: 1) to ensure appropriate and timely treatment of structural heart disease patients; 2) to minimize the risk of COVID-19 exposure to patients and health care workers; and 3) to limit resource utilization under conditions of constraint. Although the degree of disruption to usual practice will vary across the United States and elsewhere, we hope that early experiences from a heart team operating in the current global epicenter of COVID-19 may prove useful for others adapting their practice in advance of local surges of COVID-19.