An Indian study: impact of COVID-19 on clinical decision-making and consensus in cardiac surgery practice across the country

Abstract

Purpose There is a paucity of evidence and guidelines to support clinical decisions in the present unprecedented time. We aimed to use the experience and consensus of the cardiac surgeons for clinical decisions until evidence-based guidelines are formed. Methods An electronic questionnaire was emailed to all the 1434 members of the Indian Association of Cardiovascular and Thoracic Surgery, starting from May 13, 2020, and the members were followed up with reminder emails. For a wider reach, social media like WhatsApp was also used to circulate the questionnaire. Participation was voluntary and anonymized. An effective consensus was considered when > 70% opted the same opinion, and moderate consensus when > 50% opted the same opinion. Results A total of 174 responses were obtained from the surgeons across the country. An effective consensus was obtained for the following: (i) emergency surgery in acute type A aortic dissection, (ii) urgent surgery in significant left main stem disease and mitral/aortic valves with pulmonary oedema, (iii) elective surgery in stable triple vessel disease and (iv) preoperative nasal swab examination for all patients undergoing surgery. Conclusion In the present era, where evidence is evolving and the country is entering a phase after lockdown, the surgeons face a dilemma in operating patients. These consensuses provide interim recommendation; still further evidence is published.

Outcomes of acute type A aortic dissection during the COVID‐19 pandemic: An analysis of the Society of Thoracic Surgeons Database

“…17 In light of the burden on hospital resources during regional surges of COVID- 18 This emphasis on early surgical repair even during COVID-19 pandemic has been reinforced by cardiothoracic surgeons' perceptions in multiple survey studies. [19][20][21][22][23] Just as some series have identified higher rates of mechanical complications from delayed presentation of patients ST-elevation myocardial infarction, there is speculation that a higher incidence of patients with chronic type A dissection will occur in the future. While a small case series, a recent report from Switzerland detailed their prior 5-year experience with type A aortic dissection, with zero reported cases of chronic dissection, whereas there were two cases between February and May 2020.…”

“…Nevertheless, it should be emphasized that early surgical repair remains the preferred treatment for most patients with ATAAD notwithstanding COVID‐19 status 18 . This emphasis on early surgical repair even during COVID‐19 pandemic has been reinforced by cardiothoracic surgeons' perceptions in multiple survey studies 19–23 …”

The day after tomorrow: cardiac surgery and coronavirus disease-2019

“…Similarly, an Indian survey, 21 in the wake of IACTS guidelines, 31 reported a 50% reduction in elective surgery. Most surgeons converged on the urge to operate on aortic type A dissection, significant proximal stenosis of the left main trunk, and heart valve disease causing pulmonary edema or unresponsive heart failure.…”

COVID‐19: An Indian perspective

“…An online study was conducted by our team among the cardiac surgeons practicing in India. 5 It was noted that 27% of the surgeons did not operate during the lockdown and nearly 90% of the surgeons stopped elective surgery before 31st March 2020. Just over 1/5th of the surgeons (22.2%) continued to perform elective surgeries during the period of lockdown.…”