INTRODUCTION
The novel Coronavirus (SARS-CoV-2) cause of the clinical syndrome COVID-19, associates a high incidence of severe acute respiratory syndrome requiring invasive mechanical ventilation. Due to the rapid expansion of the infection and the disease, the World Health Organisation (WHO) declared COVID-19 a global pandemic on the 11th March 2020.[1]
Since then an important restructuring of the healthcare system has taken place and all elective surgical activity has been put on hold to reallocate intensive care beds preferentially to COVID-19 patients.
Before the pandemic was declared and screening protocols were not fully established, surgical activity continued without personal protective equipment (PPE) measures which is now the standard of care universally [2]. Several reports, mainly from China, describe high rate of mortality (up to 25%) and morbidity (over 40% need for prolonged mechanical ventilation) in patients who underwent surgical procedures and were diagnosed of COVID-19 during the peri-operative period [3, 4]. In our own experience, the development of COVID-19 in the immediate postoperative period after cardiac surgery carries a mortality up to 44%.
Since the declaration of the Pandemic in London, we concentrated in improving preoperative screening measures and defer cardiac surgery in positive patients when time permitting. Some symptomatic patients were treated with alternative treatment options e.g.PCI or TAVI.
For urgent conditions, there is an opportunity for deferring surgery until COVID-19 conversion from positive to negative, while monitoring the patients for their cardiac condition closely in the hospital environment and revisit the timing of the operation if there is a clinical change. For emergency conditions, however, there may not be enough time for COVID-19 screening, and a balanced decision should be taken weighing the cardiac-related mortality against the COVID-19-related mortality if proven positive.
It is, however, uncertain how to predict when a COVID-19 positive patient will become negative (and not just a false negative) and the duration of appropriate waiting period between the negative result and the surgical intervention.
We aim to identify when is the earliest safe period for surgery by analysing our experience in patients who underwent cardiac surgery after recovering from COVID-19.