Abstract
Lack of scientific data on the feasibility and safety of minimally invasive cardiac surgery (MICS) during the COVID-19 pandemic has made clinical decision making challenging. This survey aimed to appraise MICS activity in UK cardiac units and establish a consensus amongst front-line MICS surgeons regarding standard best MICS practise during the pandemic. An online questionnaire was designed through the 'googleforms' platform. Responses were received from 24 out of 28 surgeons approached (85.7%), across 17 cardiac units. There was a strong consensus against a higher risk of conversion from minimally invasive to full sternotomy (92%; n = 22) nor there is increased infection (79%; n = 19) or bleeding (96%; n = 23) with MICS compared to full sternotomy during the pandemic. The majority of respondents (67%; n = 16) felt that it was safe to perform MICS during COVID-19, and that it should not be halted (71%; n = 17). London cardiac units experienced a decrease in MICS (60%; n = 6), whereas non-London units saw no reduction. All London MICS surgeons wore an FP3 mask compared to 62% (n = 8) of non-London MICS surgeons, 23% (n = 3) of which only wore a surgical mask. London MICS surgeons felt that routine double gloving should be done (60%; n = 6) whereas non-London MICS surgeons held a strong consensus that it should not (92%; n = 12). Whilst more robust evidence on the effect of COVID-19 on MICS is awaited, this survey provides interesting insights for clinical decision-making regarding MICS and aids to facilitate the development of standardised MICS guidelines for an effective response during future pandemics.
Highlights
Invasive cardiac surgery (MICS) refers to surgical techniques that minimise surgical trauma through smaller incisions[1] compared to the conventional open sternotomy
The World Health Organisation[6] declared a pandemic on March 11th, 2020 and as of just getting some normality now (July) 11th, there are over 12.5 million confirmed cases of COVID-19.7 Cardiac surgery is one of the single largest users of intensive care unit (ICU) beds.[8] and surgical activity has been significantly affected during this time to facilitate re-allocation of ICU beds, ventilators and staff.[9]
The survey showed that 58% (n = 14) of minimally invasive cardiac surgery (MICS) surgeons who responded in the survey perform both minimally invasive mitral valve repair (MIMVr) and minimally invasive aortic valve replacement (MIAVR) as part of their routine clinical practise
Summary
Invasive cardiac surgery (MICS) refers to surgical techniques that minimise surgical trauma through smaller incisions[1] compared to the conventional open sternotomy. The lack of scientific data on the feasibility of MICS practise during the COVID-19 pandemic has made clinical decision making challenging. Lack of scientific data on the feasibility and safety of minimally invasive cardiac surgery (MICS) during the COVID-19 pandemic has made clinical decision making challenging. This survey aimed to appraise MICS activity in UK cardiac units and establish a consensus amongst front-line MICS surgeons regarding standard best MICS practise during the pandemic. Conclusion: Whilst more robust evidence on the effect of COVID-19 on MICS is awaited, this survey provides interesting insights for clinical decision-making regarding MICS and aids to facilitate the development of standardised MICS guidelines for an effective response during future pandemics
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