Management of congenital cardiac surgery during COVID-19 pandemic

Abstract

The new Coronavirus infection, which was first seen in China in late December 2019 and eventually became a worldwide pandemic, poses a serious threat to public health. After a high spike in the number of new COVID-19 infection cases following increase in overall daily death toll in Turkey, Turkish Ministry of Health has taken immediate precautions to postpone elective surgeries in order to reduce the burden to the healthcare system which might be challenged. Whereas different areas of medicine were able to suspend their operative procedures during this period, this was not completely possible in pediatric cardiovascular surgery due to the severity and urgency of congenital heart disease patients requiring operation. Based on the guideline that was published by the Turkish Pediatric Cardiology and Cardiac Surgery Association, in which the patients requiring surgical intervention during the Covid-19 pandemic period are ranked according to the priority, directions were given regarding the operations that hereby, be delayed, we report our experience in 29 cases retrospectively, regarding the preoperative evaluation of these patients, makings of an emergency operation decision, and strategies taken about intraoperative and postoperative management and arrangements during the pandemic period. In this article, we present crucial precautions that was applied in pediatric cardiovascular surgery and extensive list of cases in order to deliver highest level of the patient safety and protection for the surgical team.

Pre-operative assessment of pediatric congenital heart disease patients in the COVID-19 era: lessons learned

“…In light of the above, several congenital heart disease centers recommended adopting a patient triage that is based on surgical urgency and necessity. This triage can decrease the risk of COVID-19 transmission and ensure the delivery of emergent medical care to all patients, especially in the current era of limited medical resources 9,12,13 . It can provide an effective and just distribution of the available resources among COVID-19 and non-COVID-19 patients.…”

Exploring the impact of the COVID‐19 pandemic on cardiac surgical services: A scoping review

“…The infant patients were extubated as urgently as possible while using PPE and following all steps for intubation 16 . Once hemodynamic stability was attained, the patients were transferred to the ward after ICU stay was over 16 . Before the transfer however, chest draining tubes and urinary catheters were removed and keeping in mind the possibility of transmission, all social isolation rules were abided by 16 …”

“…In case of postoperative care, 4 of 29 patients, at Ankara Hospital Pediatric Cardiovascular Surgery patients, were COVID‐19 suspects. Two of the patients had ARDS and were treated as positive even though their PCR tests were negative 16 . The infant patients were extubated as urgently as possible while using PPE and following all steps for intubation 16 .…”

Congenital heart disease and incremental risks of COVID‐19

“…Another study looking specifically at pediatric patients, proposes a surgical priority classification based on the type of congenital heart defect. These are divided into three classes of urgency of operation: emergent (24–48 h), urgent (1–2 weeks), and elective (beyond 2 weeks) 27 . Both papers provide a reasonable method of prioritizing cases, however, no guidelines can account for the unpredictability of COVID‐19.…”

“…Patel et al 26 (beyond 2 weeks). 27 Both papers provide a reasonable method of prioritizing cases, however, no guidelines can account for the unpredictability of COVID-19. Fortunately, nosocomial infection with SARS-CoV-2 has been shown to be insignificant compared to that acquired in the community.…”