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A multicentre roadmap to restart elective cardiac surgery after COVID-19 peak in an Italian epicenter

Fabrizio Rosati1, Claudio Muneretto1, Massimo Baudo1

  • 1Division of Cardiac Surgery, Spedali Civili di Brescia, University of Brescia, Brescia, Italy.

Journal of Cardiac Surgery
|June 26, 2021
PubMed

Insights

Restarting elective cardiac surgery during COVID-19 is feasible with a clean path protocol. Mild lung inflammation from prior coronavirus disease 2019 (COVID-19) infection does not necessitate delaying surgery.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Thoracic Surgery
  • Public Health

Background:

  • Resuming elective surgeries during the COVID-19 pandemic required careful planning.
  • Hospitals needed to manage both COVID-19 patients and non-COVID-19 surgical candidates.
  • Establishing a
  • clean path
  • protocol was crucial for patient safety.

Purpose of the Study:

  • To assess the safety and feasibility of restarting elective cardiac surgery during the COVID-19 pandemic.
  • To evaluate the impact of prior COVID-19 infection on surgical outcomes.
  • To determine the effectiveness of a multi-step screening process for surgical candidates.

Main Methods:

  • A four-step screening roadmap was implemented for 259 elective cardiac surgery patients.
  • Screening included questionnaires, nasopharyngeal swabs, and CT scans with CO-RADS scoring.
  • Data were collected from May to July 2020 across three surgical centers.

Main Results:

  • Only 0.8% of patients tested positive for COVID-19 pre-operatively.
  • 6.3% of chest CT scans showed mild to moderate lung inflammation (CO-RADS 2-4), which did not delay surgery.
  • Perioperative mortality was 1.15%, with no reported periprocedural COVID-19 contagion or rehospitalizations.

Conclusions:

  • A structured screening protocol enables the safe resumption of elective cardiac surgery during a pandemic.
  • Mild CT findings of prior COVID-19 pneumonia should not postpone necessary surgical interventions.
  • Age and cardiopulmonary bypass time were identified as risk factors for pulmonary complications.
Abstract

Keywords:
cardiac surgerycoronavirus disease 2019public health

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