Cardiac Surgery in the Post-COVID-19 Era

Given that elective cardiac surgery activity has fallen by at least 50% according to Salenger et al., the post-COVID-19 period should result in an increase of 216 – 263% in the number of patients to be treated per month [5]. The period required to absorb the delay in patient management will vary between 1 and 8 months, depending on the date of resumption of full activities and the capacity of hospitals to absorb these volumes [5]. There will be coronary patients who have had an inadequately managed myocardial infarction, resulting in complications such as heart failure, myocardial aneurysm, and mitral insufficiency due to chordal or papillary muscle rupture and other mechanical complications. There will be patients suffering from severe aortic valve stenosis presenting syncope, severe dyspnea at rest or resting angina. There will also be patients with severe mitral valve insufficiency complicated by acute pulmonary edema. These complicated patients require a longer intensive care unit (ICU) stay and more resources, and have higher morbidity and mortality rates. To be able to absorb these potentially complicated patients who were not given much attention during the pandemic, hospitals have to ensure that the necessary material and human resources are available. Unfortunately, they usually suffer from budget restrictions and are under the influence of drastic cost-cutting programs, which adds challenges to increase their capacities. With less cases being reported, more ICU beds which were previously dedicated to COVID-19 patients are now becoming available, and elective cardiac surgery activity will soon resume as usual. In addition, residents as well as fellows who have been impacted by the COVID-19 crisis should resume their residency and fellowship programs. In fact, at the peak of the pandemic, all educational and learning programs were stopped and all caregivers were assigned to the resuscitation care units dedicated to COVID-19 cases. Given that the coronavirus may not disappear in the immediate future and a second wave is plausible, cardiac surgery Humanity is experiencing the worst global disaster since the Second World War. On August 17, 2020, more than 21 million patients have been affected by coronavirus disease (COVID)-19 and the infectious disease has killed more than 750,000 people worldwide [1]. Since the COVID-19 outbreak, cardiac surgery was severely impacted with a drastic reduction in elective activity. Only urgent surgeries were provided to the patients with emergent needs during the peak of the pandemic. This editorial discusses the resumption of elective cardiac surgery based on the current situation.