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Practice Guideline
. 2020 Jun;36(6):952-955.
doi: 10.1016/j.cjca.2020.04.001. Epub 2020 Apr 8.

Cardiac Surgery in Canada During the COVID-19 Pandemic: A Guidance Statement From the Canadian Society of Cardiac Surgeons

Ansar Hassan  1 , Rakesh C Arora  2 , Corey Adams  3 , Denis Bouchard  4 , Richard Cook  5 , Derek Gunning  6 , Yoan Lamarche  4 , Tarek Malas  7 , Michael Moon  8 , Maral Ouzounian  9 , Vivek Rao  9 , Fraser Rubens  10 , Philippe Tremblay  11 , Richard Whitlock  12 , Emmanuel Moss  13 , Jean-François Légaré  14 ; Canadian Society of Cardiac Surgeons
Affiliations
Practice Guideline

Cardiac Surgery in Canada During the COVID-19 Pandemic: A Guidance Statement From the Canadian Society of Cardiac Surgeons

Ansar Hassan et al. Can J Cardiol. 2020 Jun.

Abstract
in English, French

On March 11, 2020, the World Health Organization declared that COVID-19 was a pandemic.1 At that time, only 118,000 cases had been reported globally, 90% of which had occurred in 4 countries.1 Since then, the world landscape has changed dramatically. As of March 31, 2020, there are now nearly 800,000 cases, with truly global involvement.2 Countries that were previously unaffected are currently experiencing mounting rates of the novel coronavirus infection with associated increases in COVID-19-related deaths. At present, Canada has more than 8000 cases of COVID-19, with considerable variation in rates of infection among provinces and territories.3 Amid concerns over growing resource constraints, cardiac surgeons from across Canada have been forced to make drastic changes to their clinical practices. From prioritizing and delaying elective cases to altering therapeutic strategies in high-risk patients, cardiac surgeons, along with their heart teams, are having to reconsider how best to manage their patients. It is with this in mind that the Canadian Society of Cardiac Surgeons (CSCS) and its Board of Directors have come together to formulate a series of guiding statements. With strong representation from across the country and the support of the Canadian Cardiovascular Society, the authors have attempted to provide guidance to their colleagues on the subjects of leadership roles that cardiac surgeons may assume during this pandemic: patient assessment and triage, risk reduction, and real-time sharing of expertise and experiences.

Le 11 mars 2020, l’Organisation mondiale de la Santé a déclaré que l’épidémie de COVID-19 était une pandémie. À ce moment, on rapportait seulement 118 000 cas à l’échelle mondiale, dont 90 % s’étaient déclarés dans quatre pays. Depuis, la situation dans le monde a radicalement changé. Au 31 mars 2020, on comptait près de 800 000 cas répartis partout dans le monde. Des pays qui n’avaient jusque-là pas été touchés voient le nombre de nouveaux cas d’infection monter en flèche, les décès liés à la COVID-19 augmentant par le fait même. À l’heure actuelle, plus de 8 000 cas de COVID-19 ont été rapportés au Canada, les taux d’infection variant considérablement d’une province et d’un territoire à l’autre. En raison de préoccupations quant aux ressources de plus en plus limitées, les chirurgiens en cardiologie du Canada ont dû modifier radicalement leurs pratiques cliniques. Avec l’aide des leurs équipes de cardiologie, les chirurgiens en cardiologie doivent réévaluer leurs méthodes afin de prendre en charge le mieux possible leurs patients, notamment en établissant l’ordre de priorité des cas, en reportant le traitement des cas non urgents et en modifiant leurs stratégies thérapeutiques auprès des patients présentant un risque élevé. C’est dans ce contexte que la Société canadienne des chirurgiens cardiaques et son conseil d’administration ont entrepris de formuler un ensemble de déclarations directrices. Les auteurs, qui proviennent de partout au pays et qui ont bénéficié du soutien de la Société canadienne de cardiologie, ont tenté de formuler des recommandations à l’intention de leurs confrères et consœurs pour les aider à assumer le rôle de leader qu’ils sont appelés à jouer durant la pandémie, notamment en matière d’évaluation et de triage des patients, d’atténuation des risques et de partage de leur expertise et de leurs expériences en temps réel.

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Figures

Figure 1
Figure 1
Visual abstract of the guiding principles for the cardiac surgery.
Figure 2
Figure 2
Suggested template for patient triage for cardiac surgery procedures to be modified based on local context, infrastructure, and capacity. AS, aortic stenosis; ASD, atrial septal defect; CAD, coronary artery disease; EF, ejection fraction; LM, left main; LOS, length of stay; MR, mitral regurgitation; PFO, patent foramen ovale; TAVI, transcatheter aortic valve implantation.
See this image and copyright information in PMC

References

    1. WHO Director-General's Opening Remarks at the Media Briefing on COVID-19 - 11 March 2020. World Health Organization. www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at... March 11, 2020. Accessed April 1, 2020.
    1. Coronavirus Disease (COVID-19) Situation Dashboard. World Health Organization, April 1, 2020. https://experience.arcgis.com/experience/685d0ace521648f8a5beeeee1b9125cd Accessed April 1, 2020.
    1. Public Health Agency of Canada Government of Canada. Canada.ca, Government of Canada, April 1, 2020. https://www.canada.ca/en/public-health/services/diseases/2019-novel-coro... Accessed April 1, 2020.
    1. Wood DA, Sathananthan J, Cohen EA. Precautions and procedures for coronary and structural cardiac interventions during the COVID-19 pandemic: guidance from Canadian Association of Interventional Cardiology [e-pub ahead of print]. Can J Cardiol, 10.1016/j.cjca.2020.03.027. - DOI - PMC - PubMed
    1. Groeneveld G.H., van Paassen J., van Dissel J.T. Influenza season and ARDS after cardiac surgery. N Engl J Med. 2018;378:772–773. - PubMed

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