Cardiovascular surgery in COVID-19: Change and countermeasure_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHU Jiade ^1,2 ,  GUO Huiming ^1,2

1. Department of Cardiovascular Surgery, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, P. R. China;
2. Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangzhou, 510080, P. R. China;

Corresponding author：

GUO Huiming, Email: guohuiming@gdph.org.cn

Keywords：

COVID-19 pandemic; cardiac surgery; diagnosis and therapy strategy; management strategy

DOI：

10.7507/1007-4848.202301014

Video：

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The coronavirus disease 2019 (COVID-19) epidemic has a tremendous impact on the countries around the world since the outbreak in December 2019. From December 2022, with the loosening of domestic epidemic control policies, the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) rose significantly and reached to its epidemic peak in the majority of the cities in China, which further overwhelmed our medical care system. The cardiac surgery departments in China lack the experience in conducting work under the COVID-19 pandemic. In this paper, we summarize the main topics that might be faced during the pandemic by reviewing the previous related literatures, which included: the cardiac surgery volume trends, the impact of SARS-CoV-2 infection on the prognosis of cardiac surgery, the timing of cardiac surgery and the surgical strategy should be modified, and possible recommendations for the manager or governors during the pandemic, so as to outline a path forward for cardiac surgery for the near future.

Citation： ZHU Jiade, GUO Huiming. Cardiovascular surgery in COVID-19: Change and countermeasure. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(2): 162-166. doi: 10.7507/1007-4848.202301014 Copy

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2.	Niv A, Jessica GL, Nguyen TC. COVID-19 North American Cardiac Surgery Survey Working Group. Cardiac surgery in North America and coronavirus disease 2019 (COVID-19): Regional variability in burden and impact. J Thorac Cardiovasc Surg, 2021, 162(3): 893-903.
3.	Nguyen TC, Thourani VH, Nissen AP, et al. The effect of COVID-19 on adult cardiac surgery in the United States in 717103 patients. Ann Thorac Surg, 2022, 113(3): 738-747.
4.	Haft JW, Alturi P, Alawadi G, et al. Adult cardiac surgery during the COVID-19 pandemic: A tiered patient triage guidance statement. Ann Thorac Surg, 2020, 110(2): 697-700.
5.	Baigent C, Windecker S, Andreini D, et al. ESC guidance for the diagnosis and management of cardiovascular disease during the COVID-19 pandemic: Part 2-care pathways, treatment, and follow-up. Eur Heart J, 2022, 43(11): 1059-1103.
6.	Rubino AS, De Santo LS, Pisano A, et al. Cardiac surgery practice during the COVID-19 outbreak: A multicentre national survey. Eur J Cardiothorac Surg, 2021, 59(4): 901-907.
7.	Nguyen TC. Impact of COVID-19 on adult cardiac surgery: An analysis of the STS ACSD. Presented at: The 57th Annual Meeting of the Society of Thoracic Surgeons, January 29-31, 2021 [virtual].
8.	Yates MT, Balmforth T, Kirmani BH, et al. A multi-centre prospective cohort study of patients on the elective waiting list for cardiac surgery during the COVID-19 pandemic. J Roy Soc Medicine, 2022, 115(9): 348-353.
9.	Salenger R, Etchill EW, Ad N, et al. The surge after the surge: Cardiac surgery post-COVID-19. Ann Thorac Surg, 2020, 110(6): 2020-2025.
10.	Li B, Yang J, Zhao F, et al. Prevalence and impact of cardiovascular metabolic diseases on COVID-19 in China. Clin Res Cardiol, 2020, 109(5): 531-538.
11.	Sandoval Y, Januzzi JL, Jaffe AS. Cardiac troponin for assessment of myocardial injury in COVID-19: JACC review topic of the week. J Am Coll Cardiol, 2020, 76(10): 1244-1258.
12.	Clerkin KJ, Fried JA, Raikhelkar J, et al. COVID-19 and cardiovascular disease. Circulation, 2020, 141(20): 1648-1655.
13.	Thachil J, Tang N, Gando S, et al. ISTH interim guidance on recognition and management of coagulopathy in COVID-19. J Thromb Haemost, 2020, 18(5): 1023-1026.
14.	COVIDSurg Collaborative. Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: An international cohort study. Lancet, 2020, 396(10243): 27-38.
15.	Spadaccio C, Rose D, Candura D, et al. Effect of hospital-associated SARS-CoV-2 infections in cardiac surgery. A multicenter study. Ann Thorac Surg, 2022: S0003-4975(22)00802-5.
16.	Boghdadly KE, Cook TM, Goodacre T, et al. Timing of elective surgery and risk assessment after SARS-CoV-2 infection: An update. Anaesthesia, 2022, 77(5): 580-587.
17.	Benedetto U, Goodwin A, Kendall S, et al. A nationwide survey of UK cardiac surgeons' view on clinical decision making during the coronavirus disease 2019 (COVID-19) pandemic. J Thorac Cardiovasc Surg, 2020, 160(4): 968-973.
18.	Mihalj M, Mosbahi S, Schmidli J, et al. Providing safe perioperative care in cardiac surgery during the COVID-19 pandemic. Best Pract Res Clin Anaesthesiol, 2021, 35(3): 321-332.
19.	COVIDSurg Collaborative, GlobalSurg Collaborative. Timing of surgery following SARS-CoV-2 infection: An international prospective cohort study. Anaesthesia, 2021, 76(6): 748-758.
20.	Axel-House DB, Lavingia R, Rafferty M, et al. The estimation of diagnostic accuracy of tests for COVID-19: A scoping review. J Infect, 2020, 81(5): 681-697.
21.	Zhao K, Ai L, Zhao Y, et al. Diagnostic value of using a combination of nucleic acid and specific antibody tests for SARS-CoV-2 in coronavirus disease 2019. Epidemiol Infect, 2021, 149: e62.
22.	NHS. Clinical guide for the management of cardiothoracic surgery patients during the Coronavirus Pandemic. https://scts.org/wp-content/uploads/2020/04/NHSClinical-guide-for-the-management-of-cardiothoracic-surgery-patients-during-the-Coronavirus-pandemic-20th-March-2020.pdf.
23.	George I, Salna M, Kobsa S, et al. The rapid transformation of cardiac surgery practice in the coronavirus disease 2019 (COVID-19) pandemic: Insights and clinical strategies from a center at the epicenter. J Thorac Cardiovasc Surg, 2020, 160(4): 937-947.
24.	Russell B, Moss C, George G, et al. Associations between immune-suppressive and stimulating drugs and novel COVID-19—A systematic review of current evidence. Ecancermedicalscience, 2020, 14: 1022.
25.	Chau VQ, Oliveros E, Mahmood K, et al. The imperfect cytokine storm: Severe COVID-19 ith ARDS in a patient on durable LVAD support. JACC Case Rep, 2020, 2(9): 1315-1320.
26.	Bottio T, Bagozzi L, Fiocco A, et al. COVID-19 in heart transplant recipients: A multicenter analysis of the northern Italian. JACC: Heart Fail, 2021, 9(1): 52-61.
27.	DeFilippis EM, Reza N, Donald E, et al. Considerations for heart failure care during the COVID-19 pandemic. JACC: Heart Fail, 2020, 8(8): 681-691.
28.	Fattouch K, Corrao S, Augugliaro E, et al. Cardiac surgery outcomes in patients with coronavirus disease 2019 (COVID-19): A case-series report. J Thorac Cardiovasc Surg, 2022, 163(3): 1085-1092.
29.	Folesani G, Botta L, Pacini D. Cardiac surgery model during COVID-19 pandemic: Now it's time to ramp up. Ann Thorac Surg, 2021, 111(2): 737-738.
30.	Hollenberg SM, Janz DR, Hua M, et al. COVID-19: Lessons learned, lessons unlearned, lessons for the future. Chest, 2022, 162(6): 1297-1305.
31.	Jessop ZM, Dobbs TD, Ali SR, et al. Personal protective equipment for surgeons during COVID-19 pandemic: Systematic review of availability, usage and rationing. Br J Surg, 2020, 107(10): 1262-1280.

1. COVIDSurg Collaborative. Elective surgery cancellations due to the COVID-19 pandemic: Global predictive modelling to inform surgical recovery plans. Br J Surg, 2020, 107(11): 1440-1449.
2. Niv A, Jessica GL, Nguyen TC. COVID-19 North American Cardiac Surgery Survey Working Group. Cardiac surgery in North America and coronavirus disease 2019 (COVID-19): Regional variability in burden and impact. J Thorac Cardiovasc Surg, 2021, 162(3): 893-903.
3. Nguyen TC, Thourani VH, Nissen AP, et al. The effect of COVID-19 on adult cardiac surgery in the United States in 717103 patients. Ann Thorac Surg, 2022, 113(3): 738-747.
4. Haft JW, Alturi P, Alawadi G, et al. Adult cardiac surgery during the COVID-19 pandemic: A tiered patient triage guidance statement. Ann Thorac Surg, 2020, 110(2): 697-700.
5. Baigent C, Windecker S, Andreini D, et al. ESC guidance for the diagnosis and management of cardiovascular disease during the COVID-19 pandemic: Part 2-care pathways, treatment, and follow-up. Eur Heart J, 2022, 43(11): 1059-1103.
6. Rubino AS, De Santo LS, Pisano A, et al. Cardiac surgery practice during the COVID-19 outbreak: A multicentre national survey. Eur J Cardiothorac Surg, 2021, 59(4): 901-907.
7. Nguyen TC. Impact of COVID-19 on adult cardiac surgery: An analysis of the STS ACSD. Presented at: The 57th Annual Meeting of the Society of Thoracic Surgeons, January 29-31, 2021 [virtual].
8. Yates MT, Balmforth T, Kirmani BH, et al. A multi-centre prospective cohort study of patients on the elective waiting list for cardiac surgery during the COVID-19 pandemic. J Roy Soc Medicine, 2022, 115(9): 348-353.
9. Salenger R, Etchill EW, Ad N, et al. The surge after the surge: Cardiac surgery post-COVID-19. Ann Thorac Surg, 2020, 110(6): 2020-2025.
10. Li B, Yang J, Zhao F, et al. Prevalence and impact of cardiovascular metabolic diseases on COVID-19 in China. Clin Res Cardiol, 2020, 109(5): 531-538.
11. Sandoval Y, Januzzi JL, Jaffe AS. Cardiac troponin for assessment of myocardial injury in COVID-19: JACC review topic of the week. J Am Coll Cardiol, 2020, 76(10): 1244-1258.
12. Clerkin KJ, Fried JA, Raikhelkar J, et al. COVID-19 and cardiovascular disease. Circulation, 2020, 141(20): 1648-1655.
13. Thachil J, Tang N, Gando S, et al. ISTH interim guidance on recognition and management of coagulopathy in COVID-19. J Thromb Haemost, 2020, 18(5): 1023-1026.
14. COVIDSurg Collaborative. Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: An international cohort study. Lancet, 2020, 396(10243): 27-38.
15. Spadaccio C, Rose D, Candura D, et al. Effect of hospital-associated SARS-CoV-2 infections in cardiac surgery. A multicenter study. Ann Thorac Surg, 2022: S0003-4975(22)00802-5.
16. Boghdadly KE, Cook TM, Goodacre T, et al. Timing of elective surgery and risk assessment after SARS-CoV-2 infection: An update. Anaesthesia, 2022, 77(5): 580-587.
17. Benedetto U, Goodwin A, Kendall S, et al. A nationwide survey of UK cardiac surgeons' view on clinical decision making during the coronavirus disease 2019 (COVID-19) pandemic. J Thorac Cardiovasc Surg, 2020, 160(4): 968-973.
18. Mihalj M, Mosbahi S, Schmidli J, et al. Providing safe perioperative care in cardiac surgery during the COVID-19 pandemic. Best Pract Res Clin Anaesthesiol, 2021, 35(3): 321-332.
19. COVIDSurg Collaborative, GlobalSurg Collaborative. Timing of surgery following SARS-CoV-2 infection: An international prospective cohort study. Anaesthesia, 2021, 76(6): 748-758.
20. Axel-House DB, Lavingia R, Rafferty M, et al. The estimation of diagnostic accuracy of tests for COVID-19: A scoping review. J Infect, 2020, 81(5): 681-697.
21. Zhao K, Ai L, Zhao Y, et al. Diagnostic value of using a combination of nucleic acid and specific antibody tests for SARS-CoV-2 in coronavirus disease 2019. Epidemiol Infect, 2021, 149: e62.
22. NHS. Clinical guide for the management of cardiothoracic surgery patients during the Coronavirus Pandemic. https://scts.org/wp-content/uploads/2020/04/NHSClinical-guide-for-the-management-of-cardiothoracic-surgery-patients-during-the-Coronavirus-pandemic-20th-March-2020.pdf.
23. George I, Salna M, Kobsa S, et al. The rapid transformation of cardiac surgery practice in the coronavirus disease 2019 (COVID-19) pandemic: Insights and clinical strategies from a center at the epicenter. J Thorac Cardiovasc Surg, 2020, 160(4): 937-947.
24. Russell B, Moss C, George G, et al. Associations between immune-suppressive and stimulating drugs and novel COVID-19—A systematic review of current evidence. Ecancermedicalscience, 2020, 14: 1022.
25. Chau VQ, Oliveros E, Mahmood K, et al. The imperfect cytokine storm: Severe COVID-19 ith ARDS in a patient on durable LVAD support. JACC Case Rep, 2020, 2(9): 1315-1320.
26. Bottio T, Bagozzi L, Fiocco A, et al. COVID-19 in heart transplant recipients: A multicenter analysis of the northern Italian. JACC: Heart Fail, 2021, 9(1): 52-61.
27. DeFilippis EM, Reza N, Donald E, et al. Considerations for heart failure care during the COVID-19 pandemic. JACC: Heart Fail, 2020, 8(8): 681-691.
28. Fattouch K, Corrao S, Augugliaro E, et al. Cardiac surgery outcomes in patients with coronavirus disease 2019 (COVID-19): A case-series report. J Thorac Cardiovasc Surg, 2022, 163(3): 1085-1092.
29. Folesani G, Botta L, Pacini D. Cardiac surgery model during COVID-19 pandemic: Now it's time to ramp up. Ann Thorac Surg, 2021, 111(2): 737-738.
30. Hollenberg SM, Janz DR, Hua M, et al. COVID-19: Lessons learned, lessons unlearned, lessons for the future. Chest, 2022, 162(6): 1297-1305.
31. Jessop ZM, Dobbs TD, Ali SR, et al. Personal protective equipment for surgeons during COVID-19 pandemic: Systematic review of availability, usage and rationing. Br J Surg, 2020, 107(10): 1262-1280.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Cardiovascular surgery in COVID-19: Change and countermeasure

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