key: cord-0834574-d49jvws2
authors: Folesani, Gianluca; Botta, Luca; Pacini, Davide
title: Cardiac surgery model during COVID-19 pandemic: now it’s time to ramp up
date: 2020-07-09
journal: Ann Thorac Surg
DOI: 10.1016/j.athoracsur.2020.07.001
sha: 150f247281e6db35cbeca24500559367a33d2e4f
doc_id: 834574
cord_uid: d49jvws2

nan

To the Editor:

The severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) spread rapidly from China 1 worldwide and on March 11 th 2020 the WHO declared the so-called COVID-19 a pandemic. In Italy, first cases occurred at the end of January and on June 14 th there were 235,989 infected patients with 34,345 deaths(14,5%) representing the third Country for the number of infections, after USA and Spain.

Due to the high contagiousness of SARS-CoV-2, an impressive increase of hospitalizations occurred. All kind of Surgery Units stopped to treat elective cases focusing on urgent/emergent patients to minimize Intensive Care Unit beds utilization. Patients with underlying cardiovascular diseases have an increased risk of developing into the severe form of COVID-19 4 , while health-care workers are exposed to the risk of contagion or to become vectors of transmission.

Italian government imposed a nationwide lock-down on March 9 th . Emilia-Romagna is the third Region for the number of infections, after Lombardy and Piedmont, and the S.Orsola Hospital, University of Bologna, became the main regional Hub center for COVID-19. Between January 1 st and April 30 th we operated 273 adult patients. Our activity was reduced by only 30% thanks to a cooperation with a "COVID-free" private clinic.

We treated only urgent/emergent cases or those whose treatment was considered not postponable for more than a month. We also performed 8 heart transplant, 3 LVAD implant and 3 pulmonary artery thromboembolectomy.

In-hospital mortality was 1,1%(N=3/273). None of our patients were infected during hospitalization. Four patients (1,4%) became positive during the rehabilitation in other hospitals and one of those died.

Actually, in our center, each patient undergoes nasopharingeal swab one day before the hospitalization. If the test is positive the patient is not admitted and the operation postponed. If there's an emergent case, a nasopharingeal swab is performed and the patient is considered suspect until the result of the test. In case of cardiac transplant, the recipient undergoes nasopharingeal swab and also HRCT of the chest. We created a specific "COVID-19 route" for suspected patients with dedicated ICU beds and one operation room.

At the time of writing, here in Italy, new COVID-19 cases have begun to decline showing a "flattening of the curve" and the nationwide lock-down was removed on 4 th of May. Deciding when and how to resume non-urgent health care delivery can be challenging, but we strongly think that hospital systems should put effort in resources reorganization: COVID-19 slowed down our Country but cardiac surgery has to find a way to ramp up again for the sake of patients awaiting for their treatment. 

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