Cardiac Surgery during the pandemic
The State of Alarm imposed extremely harsh restrictions on the mobility of the citizens (mandatory house confinement) and on educational, commercial and national and international transport activity, closed the national borders and established the possibility of requisitioning of goods. These were amongst the harshest conditions worldwide and, in practice, a national lockdown.
The MOH took over the command of operations, granting minor management possibilities to regional and local public administrations within their sphere of competence. This included privately owned hospitals.
The MOH, autonomic authorities of Health and Management Directions of health centers organized a contingency plan for Cardiovascular Surgery services. In practice, all of material and human health resources were exclusively devoted to fighting the pandemic. Elective activity was cancelled. The surgical services moved out of the regular facilities and dedicated operating rooms converted into intensive care for COVID-19 patients.
As stated, the Spanish Society of Cardiovascular and Endovascular Surgery (SECCE) reacted very quickly issuing a number of Recommendations (21), with specific instructions and action algorithms guiding the contingency plan for cardiovascular surgery services. It was then ensured: a) the correct care of urgent and emerging patients, b) the organization of a list of preferential patients and the temporal criteria for surgery, c) the justified and safe delay of the patients for elective surgery whose illness and clinical situation allow it and d) the specific application of ECMO programs in the context of COVID-19 (18).
In the regions hardest hit by the pandemic, such as CC. AA. of Madrid and Catalonia as per national statistics and the Johns Hopkins Coronavirus Resource Center (22), attempts were made to reboot the system in the first weeks of May. Strict infection screening protocols and “clean circuits” were established for elective patients, leading to a very slow and extremely cautious restart of activity.
The changes in the organization of health care imposed by the pandemic has had an impact on worldwide surgical activity, although its quantification is difficult at the present time since at the time of writing this manuscript, we are still fighting against the virus. The experience lived in the hardest months of the crisis indicates a significant decrease in activity; as an example, in the C.A. of Madrid, about 150 patients underwent surgery in March and April, almost entirely emergent and urgent. According to the SECCE registry (21), the volume in this Community in 2018 was 4,206 major cardiac operations, which means that, in that two-month period and under normal conditions, about 750-800 patients would have undergone cardiac surgery in Madrid.
A careful analysis of the national data, from government sources of from our scientific society, will allow us to estimate in the near future the final impact of the pandemic on the global activity of cardiac surgery. By now, there are only initiatives in a smaller scope at the regional level, which shortly will offer many precise data on the activity of cardiac surgery in the COVID era.