Cardiothoracic Surgery in the Midst of a Pandemic: Operative outcomes and maintaining a COVID-19-free environment.

Balmforth, D.; Yates, M.; Lau, K.; Hussain, A.; Lopez-Marco, A.; Edmondson, S.; Oo, A.; Uppal, R.; Sepehripour, A.; Lall, K.; Roberts, N.; Salvo, C Di; Kolvekar, S.; Wong, K.; Ambekar, S.; Sheikh, A.; Adams, B.; Yap, J.; Lawrence, D.; Awad, W.; Shipolini, A.; Rathwell, C.; Rahnavardi, Mohamed; Stamenkovic, Steven; Waller, David; Wilson, Henrietta; Al-Sahaf, May

Objective In the United Kingdom, the COVID-19 pandemic has led to the cessation of elective surgery. However, there remains a need to provide urgent and emergency cardiac and thoracic surgery as well as to continue time-critical thoracic cancer surgery. This study describes our early experience of implementing a protocol to safely deliver major cardiac and thoracic surgery in the midst of the pandemic. Methods Data on all patients undergoing cardiothoracic surgery at a single tertiary referral centre in London was prospectively collated during the first 7 weeks of lockdown in the United Kingdom. A comprehensive protocol was implemented to maintain a COVID-19 free environment including the pre-operative screening of all patients, the use of full personal protective equipment in areas with aerosol generating procedures, and separate treatment pathways for patients with and without the virus Results A total of 156 patients underwent major cardiac and thoracic surgery over the study period. Operative mortality was 9% in the cardiac patients and 1.4% in thoracic patients. The pre-operative COVID-19 protocol implemented resulted in 18 patients testing positive for COVID-19 infection and 13 patients having their surgery delayed. No patients who were negative for COVID-19 infection on pre-operative screening tested positive post-operatively. However, one thoracic patient tested positive on intra-operative broncho-alveolar lavage. Conclusion Our early experience demonstrates that it is possible to perform major cardiac and thoracic surgery with low operative mortality and zero development of post-operative COVID-19 infection.