Abstract 15347: Impact of Covid-19 Pandemia on Provision of Surgical Treatment for Patients With Cardiovascular Disease

Abstract

Introduction: COVID-19 pandemia determined a reduction of healthcare offer to the general population. Hypothesis: COVID-19 pandemia increased the number of emergency operations and in particular of life-saving procedures because of the diagnostic delay due to missed follow-up or unwillingness to present to Emergency Departments for the fear of contracting the coronavirus. Methods: Retrospective analysis of surgical activity in a large Cardiac Surgery Department from 01 March to 31 May 2020 (study period) compared to the same months of 2019 (control period). Results: During the study period there were 191 operations (14% elective and 86% urgent/emergency) versus 225 (44% elective and 56% urgent/emergency) in the control period. Moreover, during the study period four patients presented acutely due to delay of diagnosis: one with ventricular septal defect and free wall rupture due to an evolving acute myocardial infarction (MI) with late presentation; another, who suffered an acute inferior MI several months earlier and did not attend regular follow-up, was operated for a ruptured pseudoaneurysm who was not previously diagnosed; another was operated for aortic and mitral valve endocarditis complicated by cardiogenic shock due to delay caused by a misdiagnosed COVID-19 pneumonia; last patient, previously operated for an acute type A aortic dissection (ATAAD), refused to attend the Emergency Department after the acute onset of back pain and was later diagnosed with severe dilatation (1.4 cm over 6 months) of the thoracic aorta and underwent endovascular stent-grafting. The first patient (who suffered a cardiac arrest after induction of anesthesia) survived with neurological deficit, the second died in the operating room, the third and fourth survived without complications. There were no similar cases in the control period. Finally, two patients were operated for an ATAAD (one COVID-19 positive died of hemorrhagic shock) in the study period versus nine in the control period. Conclusions: COVID-19 pandemia resulted in a significant reduction of cardiac surgical activity, mainly related to decrease of elective surgery and an increased number of surgical procedures for life-threatening conditions caused by delayed presentation of acute patients.