Cardiac Surgery Amid COVID-19:
In the early stages of the COVID-19 pandemic in Iran, general hospitals
provided healthcare services to patients; nevertheless, the drastic rise
in the number of infected cases in March 2020 resulted in the
overwhelming referral for COVID-19 infected cases to tertiary centers as
well. The additional strain on healthcare sectors rapidly led to the
curtailment of elective cardiac and noncardiac surgeries in the lockdown
period. The decline in the volume of elective cardiac surgeries was
palpable given that a considerable portion of such surgical patients
needed postoperative ICU care. Procedures were, thus, limited to
emergent and urgent scenarios, and even the number of patients with
aortic dissections and left main coronary artery lesions admitted to
cardiac surgery wards dropped significantly compared with a similar
period last year.
The Iranian Society of Cardiac Surgeons published a statement in
response to the postponement of elective cardiac procedures. (5) which
described multiple situations for patients with or without positive
tests for COVID-19. In patients with positive COVID-19 tests requiring
urgent or emergent cardiac surgeries, the decision to perform surgeries
should be based on the prognosis of the current disease and the
underlying comorbidities (Fig. 2). Moreover, the recommendations of the
COVID-19 team, consisting of cardiovascular surgeons, cardiologists,
cardiac anesthesiologists, intensive care specialists, infectious
disease specialists, and pulmonologists, should be considered in the
process. For patients not infected with COVID-19, it is generally
recommended that cardiac surgeries be performed in tertiary
cardiovascular centers such as Rajaie Cardiovascular Medical and
Research Center rather than in general hospitals, which were directly
involved with COVID-19 care.
Acute aortic dissection, mechanical heart valve thrombosis, and acute
coronary syndrome (especially with the left main disease) are considered
in need of prompt treatment even during the COVID-19 pandemic. However,
given the uncertainty in the future regarding fatalities of disease,
drawing a line to divide patients into specific categories is
impossible. As highlighted by other researchers, there is a need for new
clinical decision making processes and frameworks that help guide
patients to the appropriate treatment strategies (6).
Healthcare providers constitute any country’s lynchpins of protection in
the face of calamities such as viral outbreaks, and their health and
safety are crucial both for efficient patient care and for disease
control. Previous experiences with severe acute respiratory syndrome
(SARS) and Middle East respiratory syndrome (MERS) outbreaks
demonstrated that healthcare providers were under extraordinary stress
and susceptible to infection. (7) The number of infected healthcare
personnel is a reasonable index of the adequacy of PPE and the extent of
healthcare environment exhaustion. According to an unofficial report
released on June 25, 2020, approximately 2000 healthcare workers were
diagnosed with COVID-19, with the number projected to reach 5000 by the
time the outbreak has been curbed. Only in the first 2 months of the
outbreak, around 110 healthcare providers, particularly general
physicians, died after COVID-19 infection.