Stuck Between a Rock and a Hard Place: The Clinical Conundrum of
Managing Cardiac Surgical Patients During the SARS-CoV-2 Pandemic
Abstract
Deferring non-emergent cardiac surgery became the strategy of choice for
several international healthcare systems afflicted by high case burdens
of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2/COVID-19)
in order to both conserve valuable healthcare resources and protect
patients from possible exposure. Missing from the available dataset to
help guide policy development has been a clear understanding of the
extent to which COVID-19 infection modulates cardiac surgery outcomes.
In their investigation, Bonalumi and colleagues uncovered an inpatient
COVID-19 positivity rate of almost 10 times higher than that of the
general Italian population, as well as a mortality rate over 20 times
higher amongst cardiac surgery patients with perioperative COVID-19
infection compared to those COVID-negative. While the summation of
available evidence points to the serious consideration cardiac surgeons
must give to delaying surgeries during the COVID-19 pandemic,
recognition must be given to the risks that postponing cardiac surgery
may have on patient outcomes. Emerging data is beginning to demonstrate
the efficacy of vaccination in preventing postoperative COVID-19
infection and morbidity.