key: cord-0813884-y2l121y9
authors: Gaudino, Mario; Chikwe, Joanna; Hameed, Irbaz; Robinson, N. Bryce; Fremes, Stephen E.; Ruel, Marc
title: Response of Cardiac Surgery Units to COVID-19: An Internationally-Based Quantitative Survey
date: 2020-05-11
journal: Circulation
DOI: 10.1161/circulationaha.120.047865
sha: d94f4edee23f62e9b5a24e3a13f90c0c2bc7872d
doc_id: 813884
cord_uid: y2l121y9

nan

Circulation. 2020;142:300-302. DOI: 10.1161/CIRCULATIONAHA.120. 047865 July 21, 2020 301 CORRESPONDENCE This survey of 60 cardiac surgery centers (comprising 618 cardiac surgeons) across 19 countries provides a unique description of the cardiac surgery response to the COVID-19 pandemic worldwide. Most of the respondents to our survey were in the advanced phase of the pandemic with >1000 local infections. 3 Although COVID-19 patients accounted for fewer than 10% of hospital inpatients at the centers surveyed, almost twothirds of centers reported a reduction of greater than 50% in intensive care bed availability for cardiac surgery patients, which may reflect the prolonged ventilator dependence characterizing 20% to 30% of hospitalized patients with COVID-19. 4 In more than a third of centers, cardiac surgery personnel were redeployed to care for patients with COVID-19. Respondents reported a median reduction in cardiac surgery case volume by 50% to 75%. The negative effects of such suspension of all elective cardiac surgeries are unclear at the moment; however, data from healthcare systems where surgery is routinely deferred because of limited capacity have shown increased operative mortality in patients who are on a cardiac surgery waitlist. 5 Furthermore, the reduction in research activity reported by more than 50% of the centers could jeopardize the ability to promptly collect and analyze key information on the consequences of the COVID-19 crisis. A reduction in educational activity is also of concern, particularly in countries such as the United States, where cardiac surgical training is limited to 1 or 2 years.

Our study has limitations; it is a snapshot of a rapidly evolving situation, affecting heterogeneous populations with variable responses during the pandemic. Survey responses are inherently prone to subjectivity. Survey participants were drawn predominantly from large cardiac surgery centers, and responses may not reflect those of smaller community programs.

To conclude, the majority of the respondents to our survey reported reduced cardiac surgery activity, redeployed personnel, and curtailed educational and research activities in response to the COVID-19 pandemic. The widespread interruption in cardiac surgery described herein adds to the concerning observation that excess mortality not related to COVID-19 infections may now surpass mortality directly related to COVID-19 infections. Our data may also help inform the responses to the subsequent phases, if any, of this pandemic.

This study adheres to the American Heart Association's Transparency and Openness Promotion Guidelines. The first author will consider requests for data sharing.

Email mfg9004@med. cornell.edu Affiliations Department of Cardiothoracic Surgery

Randomized comparison of the clinical outcome of single versus multiple arterial grafts: the ROMA trial-rationale and study protocol

World Health Organization. Pandemic Influenza Preparedness and Response

A framework for rationing ventilators and critical care beds during the COVID-19 pandemic

Waiting times and prioritization for coronary artery bypass surgery in New Zealand

The authors thank the Cornell Joint Clinical Trial Office for their support in this project.

None.