Cardiothoracic Surgery in the Midst of a Pandemic: Operative outcomes and maintaining a COVID-19-free environment

2020 
Objective In the United Kingdom, the COVID-19 pandemic has led to the cessation of elective surgery However, there remains a need to provide urgent and emergency cardiac and thoracic surgery as well as to continue time-critical thoracic cancer surgery This study describes our early experience of implementing a protocol to safely deliver major cardiac and thoracic surgery in the midst of the pandemic Methods Data on all patients undergoing cardiothoracic surgery at a single tertiary referral centre in London was prospectively collated during the first 7 weeks of lockdown in the United Kingdom A comprehensive protocol was implemented to maintain a COVID-19 free environment including the pre-operative screening of all patients, the use of full personal protective equipment in areas with aerosol generating procedures, and separate treatment pathways for patients with and without the virus Results A total of 156 patients underwent major cardiac and thoracic surgery over the study period Operative mortality was 9% in the cardiac patients and 1 4% in thoracic patients The pre-operative COVID-19 protocol implemented resulted in 18 patients testing positive for COVID-19 infection and 13 patients having their surgery delayed No patients who were negative for COVID-19 infection on pre-operative screening tested positive post-operatively However, one thoracic patient tested positive on intra-operative broncho-alveolar lavage Conclusion Our early experience demonstrates that it is possible to perform major cardiac and thoracic surgery with low operative mortality and zero development of post-operative COVID-19 infection
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