key: cord-0868448-ispgil1a
authors: Andersen, Nicholas D.
title: Commentary: A survey of UK cardiac surgeon opinion during the COVID-19 pandemic: A point and place in time
date: 2020-07-03
journal: J Thorac Cardiovasc Surg
DOI: 10.1016/j.jtcvs.2020.06.083
sha: 8751906f4f2f4f09b41358659adffa88e528650c
doc_id: 868448
cord_uid: ispgil1a

nan

(1). 36

The evolving COVID-19 pandemic has created global challenges and obstacles to the delivery of 37 routine health care, including cardiac surgery. As cardiac surgeons, we have been tasked with 38 providing optimal care of COVID-19 patients requiring heart surgery or mechanical support, 39 optimal care of non COVID-19 patients with surgical disease, optimal care of our surgical and 40 critical care teams, and optimal care of ourselves. We have further been tasked with taking 41 leadership roles in each of these missions. The daily calculus for when and how to perform heart 42 surgery has never been more nuanced, and is highly impacted by local factors such as infection 43 rates and trends, hospital bed and resource availability, health care worker health and 44 availability, and personal protective equipment (PPE) availability, to name a few. In short, while 45 decision making and recommendations can be generalized, they cannot be applied uniformly, 46 and each cardiac unit is tasked with making real-time decisions based on their current point and 47 place in time. 48

In attempt to rapidly assess and gather cardiac surgeon opinion regarding the conduct of 49 heart surgery during the earlier phase of the pandemic (Figure 1) (1), Benedetto and colleagues 50 performed an electronic survey of UK cardiac surgeons from April 17 -21, 2020, with 86 51 respondents (2). The survey responses were generally consistent with the Society of Thoracic 52 Surgeons (STS) recommendations from this time (3). Specific areas of consensus (with > 60% 53 agreement) included screening of all patients for COVID-19 prior to heart surgery with PCR and 54 chest CT, and the use of "full PPE" in every case regardless of COVID-19 status. Other more ill-55 defined survey findings were that patients undergoing cardiac surgery were considered moderate 56 to high risk of COVID-19 exposure and would be expected to have increased mortality if it 57 occurs, and a multi-disciplinary team should be convened to decide suitability for surgery on a 58 patient by patient basis.

COVID-19 Dashboard by the The Center for Systems Science and Engineering

A nationwide survey of UK 88 cardiac surgeons' view on clinical decision making during the COVID-19 pandemic

Surgery and the COVID-19 Pandemic: Aggressive Infection Mitigation Strategies are Necessary 92 in the Operating Room and Surgical Recovery

Reintroduction of Cardiovascular Services during the COVID-19 Pandemic: Guidance from 95

Delivery of Cardiac Surgery During the COVID-19 Pandemic: A Guidance Statement from The 98

Society of Thoracic Surgeons COVID-19 Task Force

Adult cardiac 100 surgery during the COVID-19 Pandemic: A Tiered Patient Triage Guidance Statement

Thorac Surg

Although these survey responses are reasonable, a few points warrant commentary. First, 60 the use of chest CT for COVID-19 screening is currently not a uniform or evidence-based 61 practice and has not been recommended by the STS COVID-19 task force at this time (3) (4) (5) . 62Second, while the use of "full PPE" (which presumably entails an N95 mask or respirator in 63 addition to standard surgical attire) was recommended by the STS during the earlier phase of the 64 pandemic (3), more recent guidelines focused on re-introduction and ramping up of cardiac 65 surgical services have softened this stance and have suggested that these decisions should be 66 made at the hospital level based on local COVID-19 rates and PPE availability (4, 5). Third, the 67 risk of COVID-19 exposure for patients undergoing heart surgery was thought to be moderate to 68 high (i.e. if exposed it would negatively affect outcomes) but the odds that a patient would be 69 exposed to COVID-19 in the post-operative period also likely depends on local infection rates at 70 a point in time. Fourth, guidelines for patient triage for heart surgery have also been published, 71 and are again highly dependent on hospital resource availability and local infection rates (4-6). 72In short, the UK survey on cardiac surgeons' opinions during the COVID-19 pandemic 73 provides a snapshot of a specific point in time for a specific region. These opinions are important 74 and helpful for framing discussion and development of policies and guidelines within our unique 75 branch of the health care enterprise. But, institution-specific decision making should continue to 76 be made based primarily on our rapidly evolving knowledge of the behavior of COVID-19 in 77 specific patient populations, as well as analysis of real-time locoregional data by expert teams in 78 each region, including infectious disease, epidemiology, government, and hospital policy 79 makers, in addition to surgeons. It is clear that COVID-19 will require the global health care 80 community to adapt rapidly and find ways to co-exist with the virus for the foreseeable future. 81

Our opinions and attitudes regarding the delivery of cardiac surgery are similarly expected to 82 change rapidly as the pandemic evolves. 83