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Published on: February 11, 2022
The day after tomorrow: cardiac surgery and coronavirus disease-2019
Giorgia Bonalumi1, Ilaria Giambuzzi1,2, Beatrice Buratto3
1Department of Cardiovascular Surgery, Centro Cardiologico Monzino, IRCCS.
Insights
The COVID-19 pandemic significantly impacted cardiac surgery services globally. Healthcare systems adapted by reorganizing services and prioritizing urgent procedures to manage the crisis.
Area of Science:
- Cardiology
- Public Health
- Surgical Management
Background:
- The COVID-19 pandemic presented unprecedented global health challenges.
- Cardiac surgery faced significant disruptions during the initial wave of the pandemic.
Purpose of the Study:
- To review the global impact of the COVID-19 pandemic on cardiac surgery.
- To summarize guidelines and service reorganizations implemented worldwide.
Main Methods:
- Literature search for guidelines and center experiences during the pandemic.
- Review of official documents from scientific societies and multi-center studies.
- Analysis of strategies implemented in Italy, including Hub-and-Spoke models.
Main Results:
- Various international guidelines were published to manage the pandemic's impact on cardiac surgery.
- Two main approaches for stratifying surgical indications emerged: dynamic and static.
- Healthcare systems experienced significant stress due to resource reallocation for COVID-19 patients.
Conclusions:
- Cardiac surgery, like other surgical fields, reduced non-urgent activity during the pandemic.
- Adaptation strategies included service reorganization and prioritization of emergency cases.
- Effective resource allocation and adherence to guidelines were crucial for managing cardiac surgery during the crisis.
Abstract:
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.
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