Corresponding author:
Ertekin Utku Ünal, MD, Assoc. Prof
Department of Cardiovascular Surgery
Ankara City Hospital, Ankara, Turkey
Mobile: 0 532 6570637
E-mail: utkuunal@gmail.com
Coronavirus disease 2019 (COVID-19) is a remarkably challenging health
issue that provoked all the health-care providers to contemplate some
measures about the situation. All the health-care workers frontline
(esp. emergency service, pulmonologists, infection disease specialist
and anesthesiologist) have produced recommendations on prevention and
taking care of COVID-19 patient (1,2). Whereas, at the second line
another important issue is the ongoing healthcare for the continual
disease situations.
There are two main critical issues on cardiovascular surgery in this
pandemic. Firstly, to delay the elective surgeries is essential to
sustain the health-care service. Elective case triage is trickier for
cardiovascular procedures which are relatively progressive conditions.
Definitive decision to defer a procedure should be made regarding
firstly to the capacity of health-care system, and then availability of
surgical/anesthesia staff, intensive care unit beds, need for isolation
beds, ventilators, cardiopulmonary bypass machine, extracorporeal
membrane oxygenator, supplies such as sutures, grafts, valves and blood
and blood product availability. The patient status should be taken into
account to defer or to perform the procedure, as well. Therefore, we
developed “Level of Priority” (LoP) statement for cardiovascular
procedures (3). Elective cases are defined as LoP I that may be
postponed as much as possible. LoP II to IV cases should be reconsidered
by individual basis by “Heart Team”. The situations that can be
managed by percutaneous coronary intervention, endovascular procedures
and etc. may be handled by non-operative manners.
The second one is the personal protection equipment and infection
measures while dealing with a suspected / confirmed COVID-19 patient. It
is obvious that a suspected / confirmed COVID-19 patient ought to be
assessed with specific measures for any medical or surgical
intervention. Personal protection equipment (PPE) is the most crucial
measure during the pandemic. It is recognized that many centers are
facing PPE shortages and there are recommendations to re-sterile the
masks to be effective for reuse.(4) More measures should be taken into
consideration for sterile environment such as surgical procedures. Some
added measures such as face shield may be recommended for surgical
procedures. The surgical team who scrubbed in, must wear extra equipment
such as surgical coat and double gloves. It may be recommended to fix
the long-sleeve gloves to the surgical coat by adhesive drapes (3). It
is obvious that this kind of working environment with all this equipment
is challenging, sometimes irritating and disquieting. One other big
problem is the fraught feeling of health-care providers to be diseased
or to be contagious for their family. Therefore, health-care providers
may need enormous support for burnouts during the pandemic.
The other measures such as preparation of the operating room (OR),
anesthesiologic management, transportation of patients and disinfection
of OR were discussed in the referring article (3).
In conclusion, it is important to assess the “Level of Priority” for
surgical procedures to support the service of health-care facility. More
than that, whole surgical team should be protected by adequate PPE and
should take the time to get full protected.