The rapid transformation of cardiac surgery practice in the coronavirus disease 2019 (COVID-19) pandemic: Insights and clinical strategies from a center at the epicenter

Abstract

Background: The onset of the coronavirus disease 2019 (COVID-19) pandemic has forced our cardiac surgery program and hospital to enact drastic measures that has forced us to change how we care for cardiac surgery patients, assist with COVID-19 care, and enable support for the hospital in terms of physical resources, providers, and resident training. Methods: In this review, we review the cardiovascular manifestations of COVID-19 and describe our system-wide adaptations to the pandemic, including the use of telemedicine, how a severe reduction in operative volume affected our program, the process of redeployment of staff, repurposing of residents into specific task teams, the creation of operation room intensive care units, and the challenges that we faced in this process. Results: We offer a revised set of definitions of surgical priority during this pandemic and how this was applied to our system, followed by specific considerations in coronary/valve, aortic, heart failure and transplant surgery. Finally, we outline a path forward for cardiac surgery for the near future. Conclusions: We recognize that individual programs around the world will eventually face COVID-19 with varying levels of infection burden and different resources, and we hope this document can assist programs to plan for the future.

Novel Pre- and Postoperative Care Using Telemedicine

“…A recent publication from Jefferson Health in 2020 describes their division of thoracic surgery's almost complete transition to telemedicine outpatient visits in response to the COVID-19 pandemic, including both preoperative and postoperative evaluations (21). Although patient outcomes and satisfaction were not measured, similar reorganization of hospitals and outpatient clinics elsewhere in the US have made it clear that telemedicine will need to be incorporated into thoracic surgical practice for the foreseeable future to ensure the safety of patients, clinicians, and all supportive staff (22).…”

Artificial lungs––Where are we going with the lung replacement therapy?

“…Logistic and organizational aspects that are required in COVID‐19 intensive care units to protect patients and healthcare workers and to protect the community at large came to the forefront 113‐115 . Given the novel and rapidly spreading nature of COVID‐19, clinicians and policy makers around the world provided urgent reviews and summaries of evidence‐based guidelines to inform practice with complimentary access to research, education, and science without having to travel for a face‐to‐face interchange 116 . Authors and their readers subsequently communicated their findings during webinars, video conferences, and via social media channels 117 .…”

Reply: A problem of “ethic” proportions

“…The Society of Thoracic Surgeons online calculators have made inroads into this challenge with predicted ventilator durations, continuous venovenous hemofiltration probability, and so forth, but the job is far from over. In our article, 4 we sought to establish qualitative thresholds by which surgeons could more objectively decide whether to operate on a given patient during a given phase of the pandemic. However, this type of heuristic is still limited by its unit conversion.…”