The impact of COVID-19 pandemic on aortic valve surgical service: a single centre experience

Abstract

Background The coronavirus-disease 2019 (COVID-19) pandemic imposed an unprecedented burden on the provision of cardiac surgical services. The reallocation of workforce and resources necessitated the postponement of elective operations in this cohort of high-risk patients. We investigated the impact of this outbreak on the aortic valve surgery activity at a single two-site centre in the United Kingdom. Methods Data were extracted from the local surgical database, including the demographics, clinical characteristics, and outcomes of patients operated on from March 2020 to May 2020 with only one of the two sites resuming operative activity and compared with the respective 2019 period. A similar comparison was conducted with the period between June 2020 and August 2020, when operative activity was restored at both institutional sites. The experience of centres world-wide was invoked to assess the efficiency of our services. Results There was an initial 38.2% reduction in the total number of operations with a 70% reduction in elective cases, compared with a 159% increase in urgent and emergency operations. The attendant surgical risk was significantly higher [median Euroscore II was 2.7 [1.9–5.2] in 2020 versus 2.1 [0.9–3.7] in 2019 (p = 0.005)] but neither 30-day survival nor freedom from major post-operative complications (re-sternotomy for bleeding/tamponade, transient ischemic attack/stroke, renal replacement therapy) was compromised (p > 0.05 for all comparisons). Recommencement of activity at both institutional sites conferred a surgical volume within 17% of the pre-COVID-19 era. Conclusions Our institution managed to offer a considerable volume of aortic valve surgical activity over the first COVID-19 outbreak to a cohort of higher-risk patients, without compromising post-operative outcomes. A backlog of elective cases is expected to develop, the accommodation of which after surgical activity normalisation will be crucial to monitor.

Optimizing Surgical Care Amidst COVID-19: A Scoping Review of Practices and Policies

“…These data quantify the dramatic changes in cardiac surgery priorities and patient acuity resulting from COVID-19 care interruption. It highlights how managing only the most critical cases risks heightened complications, underscoring the need to maintain greater capacity [ 61 ]. Patients who underwent open or endovascular thoracic aortic procedures in one of three tertiary cardiology centers were included in a prospective study that collected data over two time periods.…”

“…Studies have revealed varying effects of COVID-19 on pediatric surgery. A tertiary hospital analysis found a 55% overall decline in procedures requiring anesthesia, with disproportionate reductions between inpatient and outpatient surgeries [ 61 ]. Another study reported a 40% decrease in pediatric fractures, although with increased time to subspecialty follow-up [ 72 ].…”

Impact of the COVID-19 Pandemic on the Use and Outcomes of Cardiac Procedures in COPD Patients

“…It has also been documented that a decrease in acute coronary syndrome hospitalizations occurred, which was partly related to the refusal of patients to go to hospital for fear of contracting SARS-CoV-2. Another influencing factor is the perioperative dependence of cardiac surgery patients on intensive care units (ICUs), which supported a significant part of the response to the COVID-19 pandemic [8,[19][20][21].…”

Calcific aortic valve stenosis and COVID-19: clinical management, valvular damage, and pathophysiological mechanisms

“…In a single-center cohort from the United States, the rate of cardiovascular events in patients receiving TAVI was 35% over 3-month versus 10% with 1-month delay [14] . A two-site center study in the UK reported an initial reduction by more than one third of all aortic valve surgery with more than two thirds reduction in elective cases balanced by a substantial increase in urgent SAVR [15] . The reported periprocedural risk was higher, whereas 30-day survival and complication rates were unchanged.…”