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.