Cardiac Surgery in the Time of Coronavirus

Speaking about cardiac surgery units, the pandemic affects our daily routine in different ways: limited intensive care unit (ICU) beds and ventilation sites, necessity to postpone elective and/or complex cardiac surgeries, shortage of healthcare workers, sick healthcare staff and/or risk of infection of our Teams, risk of developing COVID-19 after cardiac surgery, and patients with COVID-19 needing urgent cardiac operations without having a properly organized operating room and ICU. [...]some in-hospital patients might face the risk of infection by SARS-CoV-2, with a possible fatal outcome during the perioperative period4: based on the central role of interleukin-6 and other pro-inflammatory mediators to cause tissue damage during the more severe COVID-19 cases, it’s reasonable that during the postoperative period - normally characterized by a pro-inflammatory state - the patient who gets infected by SARS-CoV-2 would face an increased risk of severe COVID-195. Going through the recommendations of the United Kingdom’s National Health Service and Society for Cardiothoracic Surgery in Great Britain and Ireland9 and the American College of Surgeons10, there is no mention to which kind of patients should be preferably operate on, but definitely there are some advices to optimize the treatment, such as shorten as much as possible the LOS, minimize the blood loss11, minimize the risk of exposure to SARS-CoV-2 for patients and staff, and pay attention to in-patient bed capacity (postponing elective cases which require in-patient resources will preserve those resources for acute needs).