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A multicentre roadmap to restart elective cardiac surgery after COVID‐19 peak in an Italian epicenter
Author(s) -
Rosati Fabrizio,
Muneretto Claudio,
Baudo Massimo,
D'Ancona Giuseppe,
Bichi Samuele,
Merlo Maurizio,
Cuko Besart,
Gerometta Piersilvio,
Grazioli Valentina,
Giroletti Laura,
Di Bacco Lorenzo,
Repossini Alberto,
Benussi Stefano
Publication year - 2021
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/jocs.15776
Subject(s) - medicine , odds ratio , perioperative , confidence interval , covid-19 , cardiac surgery , incidence (geometry) , surgery , extracorporeal membrane oxygenation , disease , physics , infectious disease (medical specialty) , optics
Background During the Italian Phase‐2 of the coronavirus pandemic, it was possible to restart elective surgeries. Because hospitals were still burdened with coronavirus disease 2019 (COVID‐19) patients, it was focal to design a separate “clean path” for the surgical candidates and determine the possible effects of major surgery on previously infected patients. Methods From May to July 2020 (postpandemic peak), 259 consecutive patients were scheduled for elective cardiac surgery in three different centers. Our original roadmap with four screening steps included: a short item questionnaire (STEP‐1), nasopharyngeal swab (NP) (STEP‐2), computed tomography (CT)‐scan using COVID‐19 reporting and data system (CO‐RADS) scoring (STEP‐3), and final NP swab before discharge (STEP‐4). Results Two patients (0.8%) resulted positive at STEP‐2: one patient was discharged home for quarantine, the other performed a CT‐scan (CO‐RADS: <2), and underwent surgery for unstable angina. Chest‐CT was positive in 6.3% (15/237) with mean CO‐RADS of 2.93 ± 0.8. Mild‐moderate lung inflammation (CO‐RADS: 2–4) did not delay surgery. Perioperative mortality was 1.15% (3/259), and cumulative incidence of pulmonary complications was 14.6%. At multivariable analysis, only age and cardiopulmonary bypass (CPB) time were independently related to pulmonary complications composite outcome (age >75 years: odds ratio [OR]: 2.6; 95% confidence interval [CI]: 1.25–5.57; p = 0.011; CPB >90 min. OR: 4.3; 95% CI: 1.84–10.16; p = 0.001). At 30 days, no periprocedural contagion and rehospitalization for COVID‐19 infections were reported. Conclusions Our structured roadmap supports the safe restarting of an elective cardiac surgery list after a peak of a still ongoing COVID‐19 pandemic in an epicenter area. Mild to moderate CT residuals of coronavirus pneumonia do not justify elective cardiac surgery procrastination.