Author(s): Philippine Association of Thoracic, Cardiac and Vascular Surgeons, Inc.
Dennis M. De Asis, MD; Robin Augustine Q. Flores, MD; Avenilo L. Aventura Jr., MD; Jetz-Marion P. Cruz, MD; Redentor B. Juan, MD; Karyn P. Luna, MD; Stewart S. Santos, MD; Zab-diel R. Villanueva, MD; John M. Yam, MD; Ad Hoc Committee for Cardiac Surgery
This document tackles the recommendations to address the massive disruptions in the surgical care of patients with acquired and congenital heart diseases. Peculiar to this subset of surgical patients are the following:
- The prevalence of cardiovascular disease (CVD) among COVID-19 patients is high at 16.4%. Pre-existing CVD may predispose to COVID-19 infection.
- Infected patients with CVD have a 10.5% mortality risk due to myocarditis.
- The medicines for the management of COVID-19 have potential adverse cardiovascular effects.
- The side-effects of surgery especially cardiopulmonary bypass (CPB) can exacerbate the complications of COVID-19 infection (i.e. CPB-induced cytokine proliferation, immunosuppression, pulmonary reperfusion injury, acute kidney injury, myocardial stunning, coagulopathy, etc.). Risk assessment is, therefore, higher.
- The surgical management of CVD is resource demanding (i.e., big surgical and ICU teams with concomitant increased use of PPEs, Longer duration of ICU and in-hospital stay, etc.).
- Longer close contact (and possible COVID-19 exposure) to a patient due to an inherently prolonged duration of surgery.
- Staff risk to COVID-19 exposure during perioperative cardiac arrest resuscitation.
Highlighted are the patient selection guidelines during various phases of human and material resource constraints (i.e., during the period of very Limited resources in anticipation of the surge of COVID-19 cases, and the Loosening of restrictions to resources during the ‘flattening of the curve’).Community quarantine is not necessarily synonymous with the Level of resource availability, therefore, our recommendations are also based on resource availability determined by the hospital chief and DOH mandates.
In addition, as appropriate institutional standard PPE requirements are anticipated to be already in place, we have additional recommendations considering the inclusion of the surgical Loupes and the possibility of personnel fatigue during a Long procedure.
Topics on penetrating and blunt cardiac trauma are excluded in this document, as they are true emergencies manageable in any tertiary hospital.
Key words: cardiovascular disease, COVID-19 PCR test