Cardiac Surgery Amid COVID-19:
In the early stages of the COVID-19 pandemic in Iran, general hospitals provided healthcare services to patients; nevertheless, the drastic rise in the number of infected cases in March 2020 resulted in the overwhelming referral for COVID-19 infected cases to tertiary centers as well. The additional strain on healthcare sectors rapidly led to the curtailment of elective cardiac and noncardiac surgeries in the lockdown period. The decline in the volume of elective cardiac surgeries was palpable given that a considerable portion of such surgical patients needed postoperative ICU care. Procedures were, thus, limited to emergent and urgent scenarios, and even the number of patients with aortic dissections and left main coronary artery lesions admitted to cardiac surgery wards dropped significantly compared with a similar period last year.
The Iranian Society of Cardiac Surgeons published a statement in response to the postponement of elective cardiac procedures. (5) which described multiple situations for patients with or without positive tests for COVID-19. In patients with positive COVID-19 tests requiring urgent or emergent cardiac surgeries, the decision to perform surgeries should be based on the prognosis of the current disease and the underlying comorbidities (Fig. 2). Moreover, the recommendations of the COVID-19 team, consisting of cardiovascular surgeons, cardiologists, cardiac anesthesiologists, intensive care specialists, infectious disease specialists, and pulmonologists, should be considered in the process. For patients not infected with COVID-19, it is generally recommended that cardiac surgeries be performed in tertiary cardiovascular centers such as Rajaie Cardiovascular Medical and Research Center rather than in general hospitals, which were directly involved with COVID-19 care.
Acute aortic dissection, mechanical heart valve thrombosis, and acute coronary syndrome (especially with the left main disease) are considered in need of prompt treatment even during the COVID-19 pandemic. However, given the uncertainty in the future regarding fatalities of disease, drawing a line to divide patients into specific categories is impossible. As highlighted by other researchers, there is a need for new clinical decision making processes and frameworks that help guide patients to the appropriate treatment strategies (6).
Healthcare providers constitute any country’s lynchpins of protection in the face of calamities such as viral outbreaks, and their health and safety are crucial both for efficient patient care and for disease control. Previous experiences with severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) outbreaks demonstrated that healthcare providers were under extraordinary stress and susceptible to infection. (7) The number of infected healthcare personnel is a reasonable index of the adequacy of PPE and the extent of healthcare environment exhaustion. According to an unofficial report released on June 25, 2020, approximately 2000 healthcare workers were diagnosed with COVID-19, with the number projected to reach 5000 by the time the outbreak has been curbed. Only in the first 2 months of the outbreak, around 110 healthcare providers, particularly general physicians, died after COVID-19 infection.