Cardiac surgery transformation throughout the COVID-19 era: analysis of 12,409 patients

Previous studies documenting COVID-19's impact on cardiac surgery have been limited by short observation periods, small sample sizes, and lack of recovery pattern analysis.

This study aims the comprehensive analysis of complete pandemic cycles, utilizing Türkiye's graduated restriction model as a natural experiment to examine cardiac surgery transformation and recovery patterns.

We conducted a retrospective analysis of 12,409 consecutive patients from March 2018 to February 2024, encompassing three equal 24-month periods: pre-pandemic, pandemic, and postpandemic. Our institution maintained non-COVID status throughout the pandemic. The pandemic period was subdivided into three phases by restriction severity (early, intermediate, late) to analyze adaptation patterns.

Among 12,409 patients, emergency surgery rates doubled during pandemic (6.5%→12.7%, p <0.001). CABG procedures became dominant (64.2% vs 57.3%, +6.9 percentage points, p <0.001) while valve surgery declined (-4.8 percentage points). Although overall patient age increased (+1.0 years, p <0.001), isolated CABG patients showed minimal progression (+0.4 years), revealing age increases were driven by deferred non-CABG procedures. BMI remained stable across periods (p =0.291). Emergency rates peaked during early pandemic (14.4%) before gradual recovery. Postpandemic period demonstrated successful recovery with valve surgery reaching unprecedented levels (p <0.001).

This represents one of the largest single-center series (12,409 patients over 72 months) and provides insights that may inform future pandemic preparedness strategies in cardiac surgery. The successful post-pandemic recovery validates graduated restriction strategies over complete service suspension, offering critical insights for maintaining CABG capacity while implementing systematic valve surgery backlog management strategies during future health emergencies.