Abstract
BackgroundThe 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.MethodsData 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.ResultsThere 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.ConclusionsOur 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.
Highlights
The severe acute respiratory syndrome coronavirus 2 and the attendant coronavirus-disease 2019 (COVID19) emerged in December 2019, resulting in a pandemic declaration by the World Health Organisation by March 2020 [1]
The proportion of re-do operations did not significantly differ (8.2% in 2020 versus 3.8% in 2019, p = 0.135) and neither did the percentage of cases classified as New York Heart Association (NYHA) class III/ IV and/or Canadian Cardiovascular Society (CCS) class III/IV (76.3% in 2020 compared with 64.3% in 2019, p = 0.112)
During the initial pandemic response there was a 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
Summary
The severe acute respiratory syndrome coronavirus 2 and the attendant coronavirus-disease 2019 (COVID19) emerged in December 2019, resulting in a pandemic declaration by the World Health Organisation by March 2020 [1]. By the end of May 2020 more than 6 million cases and 374,000 fatalities had been reported worldwide; for the United Kingdom, the reported incidence was 90,000 and almost 10,000 respectively [2]. This has imposed an unprecedented burden on the provision of healthcare services in general, and surgical treatment [3]. Among other cardiac surgical teams, had the task to achieve a delicate balance between patients whose treatment could be safely postponed, versus patients with life-threatening advanced chronic or emergency disease, in the context of severely limited intensive care resources availability [5, 6].
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