Adult cardiac surgery during COVID-19 lockdown: Impact on activity and outcomes in a high-volume centre

Nader, Joseph; Anselmi, Amedeo; Tomasi, Jacques; Martin, Amandine; Aymami, Marie; Rouze, Simon; Corbineau, Hervé; Langanay, Thierry; Flecher, Erwan; Nesseler, Nicolas; Verhoye, Jean-Philippe

Background. – The coronavirus disease 2019 (COVID-19) outbreak had a direct impact on adult cardiac surgery activity, which systematically necessitates a postoperative stay in intensive care. Aim. – To study the effect of the COVID-19 lockdown on cardiac surgery activity and outcomes, by making a comparison with the corresponding period in 2019. Methods. – This prospective observational cohort study compared adult cardiac surgery activity in our high-volume referral university hospital from 9 March to 10 May 2020 versus 9 March to 10 May 2019. Data were collected in our local certified database and a national database sponsored by the French Society of Thoracic and Cardiovascular Surgery. The primary study endpoints were operative mortality and postoperative complications. Results. – With 105 interventions in 2020, our activity dropped by 57% compared with the same period in 2019. Patients were at higher risk, with a significantly higher EuroSCORE II score (3.8 ± 4.5% vs 2.0 ± 1.8%; P < 0.001) and higher rates of active endocarditis (7.6% vs 2.9%; P = 0.047) and recent myocardial infarction (9.5% vs 0%; P < 0.001). The weight and priority of the interventions were significantly different in 2020 (P = 0.019 and P < 0.001, respectively). The rate of acute aortic syndromes was also significantly higher in 2020 (P < 0.001). Operative mortality was higher during the lockdown period (5.7% vs 1.7%; P = 0.038). The postoperative course was more complicated in 2020, with more postoperative bleeding (P = 0.003), mechanical circulatory support (P = 0.032) and prolonged mechanical ventilation (P = 0.005). Only two patients (1.8%) developed a positive status for severe acute respiratory syndrome coronavirus 2 after discharge. Conclusions. – Adult cardiac surgery was heavily affected by the COVID-19 lockdown. A further modulation plan is necessary to improve outcomes and reduce postponed operations to decrease operative mortality and morbidity.