Volume 3 - Issue 3
Senior consultant Cardio Thoracic Vascular Surgeon, Kauvery Hospital, Heartcity, Trichy,India
The COVID-19 pandemic has led to unprecedented challenges on a global scale that has not been seen for many years. The COVID-19 illness is highly contagious and lack effective treatment guideline. While the healthcare systems are already overwhelmed, the surgical needs and clinical outcomes were not well evaluated. For effective surgical care to all patients during the outbreak and for COVID-19 patients, the healthcare workforce has to restructure the surgical guidelines.
The cardiac surgery is a highly invasive procedure. The accrued risk of mortality and morbidity in not performing cardiac surgery is paramount. Deferring cardiac procedures can result in detrimental consequences due to the progressive nature of the disease. In addition, the COVID-19 transmission to the patient and the healthcare worker imparts several challenges. The access to surgical care during pandemic and optimizing the surgical platform needs to be evaluated.
'FIRST WAVE' of COVID-19
The COVID-19 pandemic has vastly affected the routine hospital services worldwide.In this pandemic, the hospitals have reduced elective operations for mitigating in-hospital viral transmissions and potential COVID-19 related pulmonary complications. Postponement of elective surgeries were undertaken to reduce the exposure of patients and healthcare workers to COVID-19, allocate staffs to emergency and intensive care units and for handling the overwhelmed infrastructure. However, delaying elective surgeries often lead to substantial deterioration in health, reduced quality of life and unnecessary deaths. Limited guidelines are currently available for cardiac surgery patients. Cardiac surgery requires extensive perioperative and postoperative care, hence we proposed a protocol for our experience which aided in making clinical decision.
Institution specific recommendations
Table 1. Preoperative COVID screening protocol
Day 2 and 3
In-hospital observation for symptoms
HRCT chest scan
If any patient develops COVID-19 symptom in the screening period or if the HRCTChest is suspicious then repeat RT-PCR is performed.
Fig. 1. Screeing protocol for Suspected COVID-19 patients.
'SECOND WAVE' of COVID-19
India became the new epicentre in the second wave of COVID-19 infection. India had witnessed 26 million COVID-19 positive patients second only to US and imposed an unparalleled strain on the patients undergoing cardiothoracic surgery and also for the healthcare team. The Indian Association of Cardio-Thoracic Surgeons (IACTS) has proposed a set of guidelines for screening cardiac patients for surgery . Hence a more robust screening protocol for patient selection and timing of cardiac surgery is much needed.
Fig. 2. Cardiac patients during the pandemic.
Effects of COVID-19 on Cardiovascular System
From the first wave of COVID-19 illness, it was recognized that COVID-19 chiefly affects the respiratory system. However, it has been reported that COVID-19 can affect the cardiac system leading to myocardial injury and endothelial dysfunction. Additionally, it has been reported that COVID-19 may cause cardiac damage even without clinical features of respiratory impairment [3-4]. We operated on 56 post-COVID patients at our centre. We evaluated the cardiac patients for COVID-19 and the attender was also tested for COVID-19 in order to prevent transmission of illness and only one attender was allowed to stay with the patient.
A total of 53 patients had uneventful recovery (53/56, 94.6%). Majority of the patients were admitted for CABG (82.1%) followed by MVR (3 patients, 5.4%) and 3 patients (5.4%) had mortality during hospitalisation.
Fig. 3. Age distribution of Cardiac patients during the pandemic.
Fig. 4. Surgeries performed during pandemic.
To summarize, the overall COVID-19 patients undergoing surgery has been reduced in this pandemic. There is huge risk of acquiring perioperative COVID-19 infection in patients experiencing surgery especially during the pandemic. However, the risks have to be weighed against the risk of deferring time-sensitive surgeries. Preoperative screening for SARS CoV-2 prevents less complications attributed to COVID illness. With the COVID illness evolution, the Cardiac Surgeons have gained enormous experience for embracing the possibility of repeat waves of COVID-19 infection.
Senior consultant Cardio Thoracic Vascular Surgeon