Introduction The COVID-19 pandemic has severely impacted theatre utilization and patient care in cardiac surgery. This study assesses impact on theatre utilisation efficiency and cardiac care pathway during Covid compared to preCovid period. Method OR data for preCOVID period (1st Jan to 23rd Mar 2020) for major cardiac cases were compared to COVID period for predefined indices of OR utilisation and efficiency. Categorical variables were compared with Chi-squared and continuous variables with Man Whitney U test. P value<0.05 was considered significant. Results Total 363 surgeries were logged (304; preCovid, 59; COVID). There was significant reduction in cases/day (median 5 cases/day preCovid to 1 case/day during Covid, p<0.001). OR utilization capacity was less than 50% for 36/65 (55.4%) Covid days versus 5/59 (8.5%) preCovid days (p<0.001). Almost half the Covid days (43.1%) had no operations. Patients during Covid were younger (median 62 years vs 69 years, p<0.01) but higher risk (logEuroscore 6.6 vs 4.7, p<0.01). Index of operational efficiency (InOE) remained unchanged (preCovid;78.8% vs COVID;79%, p=0.90). Covid adversely affected Surgical efficiency (preCovid;74% vs COVID; 68.5%, p<0.001). Conclusion There was significantly decreased workflow due to reprioritization of resources. Operational service could be delivered to high efficiency despite significant changes in patient care pathways.

Background The aim of this study was to analyse the perioperative results and long term survival of re-sternotomy for surgical aortic valve replacement (SAVR) in octogenarians. Methods This is a retrospective, single centre study (Apr 2000 – Dec 2019). Perioperative data were compared for re-sternotomy with isolated SAVR (Isolated redoSAVR) and re-sternotomy with SAVR and concomitant cardiac procedure (Associated redoSAVR). Regression analyses were performed to identify predictors of in patient mortality. Hazard ratios were calculated, and Kaplan Meier survival curves were compared for groups. Results There were 163 patients (Isolated redoSAVR; 69, Associated redoSAVR; 94). Mean age was 83±3 years and mean logEuroSCORE was 21±12. Follow up was 4.2±3.5 years. Inpatient mortality was 4.9% (1.4% versus 7.4% for Isolated redoSAVR and Associated redoSAVR respectively, p=0.08). TIA/stroke rate was 8% (9% versus 7% for Isolated redoSAVR and Associated redoSAVR respectively, p=0.78). COPD was a predictor of inpatient mortality (OR; 8.86, 95%CI; 1.19, 66.11, p=0.03). Survival was 88.7% at 1 year, 86.4% at 2 years, 70.1% at 5 years, 49.5% at 7 years and 26.3% at 10 years. There was no survival difference between Isolated redoSAVR and Associated redoSAVR (logrank p=0.36, Wilcoxon p=0.84). Significant predictors of adverse long term survival were COPD, postoperative TIA/stroke and length of stay. Survival is lower than age and gender matched first time SAVR and general population of UK. Conclusions RedoSAVR in octogenarians is associated with acceptable but significant morbidity and mortality. Shared decision making should consider emerging transcatheter therapies as viable options in selected patients.

Intravenous central line catheters are often at risk of line-related thrombosis. We report on how the cardiopulmonary bypass strategy was tailored to the particular anatomical challenges with the use of an unconventional venous cannulation site to optimise intraoperative venous drainage, improve surgical exposure and avoid circulatory arrest in a case with a complex intracardiac thrombosis. This report also highlights the importance of assiduously monitoring the efficacy of anticoagulation therapy, especially in the context of small bowel syndrome.

Background The Infection of aortic valve graft conduit is still burdened by notable morbidity and mortality. Medical and surgical strategies play a crucial role in patient outcome and vary depending on infection extend into adjacent cardiac structures, systemic spread and micro-organism involved. Methods In this retrospective study, we report our experience in the management of thirty consecutive patients admitted to our centre with composite aortic valve graft infection during the period 2008-2018. We review the early and mid-term outcomes of patients who underwent a reoperation or received a conservative medical treatment. Results Twenty patients underwent redo surgery with an early mortality of 10% and a survival of 83% at 7-year follow-up. Ten patients were treated medically and experienced an early mortality of 30% and a mid-term survival of 33%. Conclusion A surgical reoperation, despite a non-negligible perioperative risk, is the only radical treatment able to provide a good survival also in patients with complicated infective endocarditis.