Consensus of UK cardiac surgeons on decision-making during the COVID-19 pandemic

  • Benedetto U & al.
  • J Thorac Cardiovasc Surg
  • 19 May 2020

  • curated by Pavankumar Kamat
  • UK Medical News
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A new survey highlights the opinions of cardiac surgeons in the UK regarding clinical decision-making during the COVID-19 pandemic. The findings were published in the Journal of Thoracic and Cardiovascular Surgery.

Eighty-six consultant cardiac surgeons across 35 cardiac units in the UK completed a 12-item web-based questionnaire. At least one senior surgeon from each unit participated in the survey.

There was a strong consensus (≥60%) for the following recommendations:

  • Every patient should receive nasopharyngeal swab, polymerase chain reaction and computed tomography of the chest prior to admission for surgery.
  • Complete personal protective equipment should be donned by the entire theatre team, irrespective of the patient’s COVID-19 status.
  • The risk of being exposed to COVID-19 exposure should be considered moderate to high for cardiac surgery candidates and likely to increase mortality if it happens.
  • The decision to perform cardiac procedures should be based on a discussion with an ad-hoc multidisciplinary team for every patient.

More than half of the surgeons agreed that patients testing positive for COVID-19 prior to salvage surgery should only be considered for surgery if asymptomatic, and that aortic and mitral valve surgeries could similarly be considered only in selected cases. 41 per cent of surgeons believed that coronary artery bypass graft surgery should be considered only in selected cases, and 33 per cent believed that percutaneous coronary intervention should remain the default strategy. Only a small proportion of surgeons were of the opinion that urgent or elective surgery should never be performed (2% and 9%, respectively).

There was a strong consensus among cardiac surgeons that the pandemic will not have a lasting effect on surgical activities and that services will normalize in the future. "In the current scenario, systematic appraisal of national expert consensus can represent a rapid and efficient instrument to support health policy makers in generating interim recommendations" the authors conclude.