Background and Aim The coronavirus disease 2019 (COVID‐19) pandemic has seen the cancellation of elective cardiac surgeries worldwide. Here we report the experience of a cardiac surgery unit in a developing country in response to the COVID‐19 crisis. Methods From 6th April to 12th June 2020, 58 patients underwent urgent or emergency cardiac surgery. Data was reviewed from a prospectively entered unit‐maintained cardiac surgery database. To ensure safe delivery of care to patients, a series of strict measures were implemented which included: a parallel healthcare system maintaining a COVID‐19 cold site, social isolation of patients for one to 2 weeks before surgery, polymerase chain reaction testing for COVID‐19, 72 hours before surgery, discrete staff assigned only to cardiac surgical cases socially isolated for 2 weeks as necessary. Results The mean age at surgery was 59.7 ± 11 years and 41 (70.7%) were male. Fifty‐two patients were hypertensive (90%), and 32 were diabetic (55.2%). There were three emergency type A aortic dissections. Forty‐seven patients underwent coronary artery bypass graft surgery with all but three performed off‐pump. Fourteen cases required blood product transfusion. One patient had postoperative pneumonia associated with chronic obstructive pulmonary disease. The median length of stay was 5.7 ± 1.8 days. All patients were discharged home after rehabilitation. There were no cases of COVID‐19 infection among healthcare workers during the study period. Conclusion These strategies allowed us to maintain a service for urgent and emergency procedures and may prove useful for larger countries when there is decrease in COVID‐19 cases and planning for the restart of elective cardiac surgery.

Situs inversus totalis considered a malposition syndrome is a very rare condition, occurring in 1 : 8000 births, usually without associated structural congenital heart disease. The diagnosis is often incidental as in this case, which presented with an acute coronary syndrome as a manifestationof multivessel coronary artery disease. Here, we present the challenges encountered during the diagnosis and management of this entity via percutaneous intervention.

Introduction: The Caribbean is a multi-ethnic society, including Caucasian, Afro-Caribbean, East Indians, Asians, Hispanics, Europeans and natives, which has a broad range of living standards. The incidence and types of heart diseases vary significantly amongst these races. We report the surgical experience (adult and paediatric) of a low volume multiethnic population service based on Trinidad and Tobago. Methods: The Adult Heart Surgery program started in November 1993. The data on a total of 878 cases (629 male, median age 67, range 18-88 years old) is reported. Of these 39.4% were diabetics and 46.5% hypertensive. The procedures performed include coronary artery bypass grafting, valve repair and replacement and major aortic surgery including emergency dissection. The paediatric heart surgery program started in Sept 1998 and a total of 279 operations have been performed (Age range, 2 weeks to 21 years) Results: Adult: Overall mortality was 3.8%. The majority of procedures were CABG (82.3%) with an overall mortality of 2.8% (0% in 2004). Off-pump CABG accounts for 43% of the total procedures (71.2% in 2004). Aortic valve surgery was carried out in 49 patients and mitral valve replacement / repair in 96 either with or without CABG. Paediatric: The majority of the procedures were VSD 111, ASD 57, TOF 23, and 88 others (including A-V canal, BT shunt, aorta coarctation) with an overall mortality of 1.5%. Conclusion: Heart surgery in a multiethnic low volume service can be performed with excellent results comparable to international standards for adults and paediatrics.

Introduction: The Caribbean is a multi-ethnic society, including Caucasian, Afro-Caribbean, East Indians, Asians, Hispanics, Europeans and natives, which has a broad range of living standards. The incidence and types of heart diseases vary significantly amongst these races. We report the surgical experience (adult and paediatric) of a low volume multiethnic population service based on Trinidad and Tobago. Methods: The Adult Heart Surgery program started in November 1993. The data on a total of 878 cases (629 male, median age 67, range 18-88 years old) is reported. Of these 39.4% were diabetics and 46.5% hypertensive. The procedures performed include coronary artery bypass grafting, valve repair and replacement and major aortic surgery including emergency dissection. The paediatric heart surgery program started in Sept 1998 and a total of 279 operations have been performed (Age range, 2 weeks to 21 years) Results: Adult: Overall mortality was 3.8%. The majority of procedures were CABG (82.3%) with an overall mortality of 2.8% (0% in 2004). Off-pump CABG accounts for 43% of the total procedures (71.2% in 2004). Aortic valve surgery was carried out in 49 patients and mitral valve replacement / repair in 96 either with or without CABG. Paediatric: The majority of the procedures were VSD 111, ASD 57, TOF 23, and 88 others (including A-V canal, BT shunt, aorta coarctation) with an overall mortality of 1.5%. Conclusion: Heart surgery in a multiethnic low volume service can be performed with excellent results comparable to international standards for adults and paediatrics.

Introduction: Same-day discharge percutaneous coronary interventions (SDD-PCI) may be quite impactful on healthcare burden for small island developing states (SIDS) such as Trinidad and Tobago. Methods: From June 2012 to November 2014, 11 patients underwent SDD trans-radial PCI and followed up at one-month and three months. Data was retrospectively reviewed from a prospectively entered unit-maintained cardiology database. Baseline patient characteristics, in-hospital expenditure, and complications were assessed. Descriptive statistical analysis was performed in Microsoft Excel. Results: The mean age at SDD-PCI was 50.90±9.96 and nine were male. Nine patients were of East Indian Caribbean ethnicity. Six were diabetic and five were hypertensive. Procedural success was 100% with no major early complication or three-months complications; patient satisfaction was achieved with a potential in-hospital savings up to $1480 USD per patient. Conclusion: This SDD approach for elective trans-radial PCI may be safe and cost-effective in properly selected patients and merits a review of relevant policy issues in Trinidad and Tobago.