Cardiac surgery practice during the COVID-19 outbreak: a multicentre national survey

doi:10.1093/ejcts/ezaa436

Multicenter Study

. 2021 Apr 29;59(4):901-907.

doi: 10.1093/ejcts/ezaa436.

Cardiac surgery practice during the COVID-19 outbreak: a multicentre national survey

Antonino Salvatore Rubino¹, Luca Salvatore De Santo¹, Antonio Pisano², Michele di Mauro³, Stefano Benussi⁴, Valentino Borghetti⁵, Alessandro Castiglioni⁶, Luigi Chiariello⁷, Andrea Colli⁸, Antonio De Bellis⁹, Carlo Maria De Filippo¹⁰, Ruggero De Paulis¹¹, Giuseppe Di Benedetto¹², Marco Di Eusanio¹³, Giuseppe Faggian¹⁴, Brenno Fiorani¹⁵, Pasquale Antonio Fratto¹⁶, Angelo Giuseppe Giuffrida¹⁷, Mattia Glauber¹⁸, Gabriele Iannelli¹⁹, Severino Iesu²⁰, Ugolino Livi²¹, Gianluca Martinelli²², Massimo Massetti²³, Pasquale Mastroroberto²⁴, Lorenzo Menicanti²⁵, Giuseppe Minniti²⁶, Fabio Miraldi²⁷, Gianfranco Montesi²⁸, Francesco Musumeci²⁹, Francesco Nicolini³⁰, Carlo Pace Napoleone³¹, Paolo Panisi³², Aniello Pappalardo³³, Francesco Patanè³⁴, Temistocle Ragni³⁵, Mauro Rinaldi³⁶, Salvatore Tribastone³⁷, Michele Triggiani³⁸, Francesco Paolo Tritto³⁹, Carlo Zebele⁴⁰, Alessandro Parolari⁴¹, Gino Gerosa⁴², Marisa De Feo¹; Italian Society for Cardiac Surgery Task Force on COVID-19 Pandemic

Collaborators, Affiliations

Collaborators

Italian Society for Cardiac Surgery Task Force on COVID-19 Pandemic:
Salvatore Rubino Antonino, De Santo Luca Salvatore, Pisano Antonio, di Mauro Michele, Benussi Stefano, Borghetti Valentino, Castiglioni Alessandro, Chiariello Luigi, Colli Andrea, De Bellis Antonio, De Filippo Carlo Maria, De Paulis Ruggero, Di Benedetto Giuseppe, Di Eusanio Marco, Faggian Giuseppe, Fiorani Brenno, Antonio Fratto Pasquale, Giuffrida Angelo Giuseppe, Glauber Mattia, Iannelli Gabriele, Iesu Severino, Livi Ugolino, Martinelli Gianluca, Massetti Massimo, Mastroroberto Pasquale, Menicanti Lorenzo, Minniti Giuseppe, Miraldi Fabio, Montesi Gianfranco, Musumeci Francesco, Nicolini Francesco, Napoleone Carlo Pace, Panisi Paolo, Pappalardo Aniello, Patanè Francesco, Ragni Temistocle, Rinaldi Mauro, Tribastone Salvatore, Triggiani Michele, Tritto Francesco Paolo, Zebele Carlo, Parolari Alessandro, Gerosa Gino, De Feo Marisa

Affiliations

¹ Department of Translational Medicine, Cardiac Surgery Unit, University of Campania, Luigi Vanvitelli, AORN dei Colli, Cardiac Surgery, Vincenzo Monaldi Hospital, Naples, Italy.
² Cardiac Anaesthesia and Intensive Care Unit, AORN Dei Colli, Monaldi Hospital, Naples, Italy.
³ Cardiology and Cardiac Surgery, API "Madonna del Ponte", Lanciano, Italy.
⁴ Cardiac Surgery Unit, Spedali Civili, Brescia, Italy.
⁵ Cardiac Surgery Unit, Azienda Ospedaliera Santa Maria, Terni, Italy.
⁶ Cardiac Surgery Unit, San Raffaele Hospital, Milan, Italy.
⁷ Cardiac Surgery Unit, Clinica Mediterranea, Naples, Italy.
⁸ Cardiac Surgery Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
⁹ Cardiac Surgery Unit, Casa di Cura San Michele, Maddaloni, Caserta, Italy.
¹⁰ Cardiac Surgery Unit, Gemelli Molise, Fondazione Giovanni Paolo II, Campobasso, Italy.
¹¹ Cardiac Surgery Unit, European Hospital, Rome, Italy.
¹² Cardiac Surgery Unit, Clinica Pineta Grande, Castel Volturno, Caserta, Italy.
¹³ Cardiac Surgery Department, Lancisi Cardiovascular Center-OORR-Polytechnic University of Marche-School of Medicine, Ancona, Italy.
¹⁴ Cardiac Surgery Unit, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy.
¹⁵ Cardiac Surgery Unit, AORNAS "San Giuseppe Moscati", Avellino, Italy.
¹⁶ Cardiac Surgery Unit, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy.
¹⁷ Cardiac Surgery Unit, AOU Policlinico-Vittorio Emanuele, Catania, Italy.
¹⁸ Cardiac Surgery Unit, Istituto Clinico Sant'Ambrogio, Milan, Italy.
¹⁹ Cardiac Surgery Unit, University of Naples Federico II, Naples, Italy.
²⁰ Cardiac Surgery Unit, A.O. San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy.
²¹ Cardiac Surgery Unit, Azienza Ospedaliero-Universitaria S. Maria della Misericordia, Udine, Italy.
²² Cardiac Surgery Unit, Clinica San Gaudenzio, Gruppo Policlinico di Monza, Novara, Italy.
²³ Cardiac Surgery Unit, Policlinico "A. Gemelli", Università Cattolica del Sacro Cuore, Rome, Italy.
²⁴ Cardiac Surgery Unit, Università degli Studi Magna Graecia, Catanzaro, Italy.
²⁵ Cardiac Surgery Unit, Centro "E. Malan", Milan, Italy.
²⁶ Cardiac Surgery Unit, Ospedale di Treviso, Treviso, Italy.
²⁷ Cardiac Surgery Unit, Università La Sapienza, Rome, Italy.
²⁸ Cardiac Surgery Unit, Università Policlinico "Le Scotte", Siena, Italy.
²⁹ Cardiac Surgery Unit, Azienda Ospedaliera San Camillo-Forlanini, Rome, Italy.
³⁰ Cardiac Surgery Unit, University of Parma, Parma, Italy.
³¹ Azienda Ospedaliera Città della Salute e della Scienza di Torino, Presidio Ospedale Infantile Regina Margherita, Torino, Italy.
³² Cardiac Surgery Unit, Humanitas Gavazzeni, Bergamo, Italy.
³³ Cardiac Surgery Unit, Ospedali Riuniti di Trieste, Italy.
³⁴ Cardiac Surgery Unit, Azienda Ospedaliera Papardo, Messina, Italy.
³⁵ Cardiac Surgery Unit, Ospedale R. Silvestrini, Perugia, Italy.
³⁶ Cardiac Surgery Unit, Azienda Ospedaliera Città della Salute e della Scienza di Torino, Presidio Molinette, Università di Torino, Torino, Italy.
³⁷ Cardiac Surgery Unit, Centro Cuore Morgagni, Pedara, Catania, Italy.
³⁸ Cardiac Surgery Unit, Ospedale Giuseppe Mazzini, Teramo, Italy.
³⁹ Cardiac Surgery Unit, AORNAS SS. Anna e Sebastiano, Caserta, Italy.
⁴⁰ Cardiac Surgery Unit, Casa di Cura Montevergine, Mercogliano (AV), Italy.
⁴¹ Department of University Cardiac Surgery and Translational Research, IRCCS Policlinico S. Donato, University of Milan, Milan, Italy.
⁴² Department of Cardiac Surgery, University of Padua, Padua, Italy.

PMID: 33657222
PMCID: PMC7989504
DOI: 10.1093/ejcts/ezaa436

Free PMC article

Multicenter Study

Cardiac surgery practice during the COVID-19 outbreak: a multicentre national survey

Antonino Salvatore Rubino et al. Eur J Cardiothorac Surg. 2021.

Free PMC article

. 2021 Apr 29;59(4):901-907.

doi: 10.1093/ejcts/ezaa436.

Authors

Collaborators

Italian Society for Cardiac Surgery Task Force on COVID-19 Pandemic:
Salvatore Rubino Antonino, De Santo Luca Salvatore, Pisano Antonio, di Mauro Michele, Benussi Stefano, Borghetti Valentino, Castiglioni Alessandro, Chiariello Luigi, Colli Andrea, De Bellis Antonio, De Filippo Carlo Maria, De Paulis Ruggero, Di Benedetto Giuseppe, Di Eusanio Marco, Faggian Giuseppe, Fiorani Brenno, Antonio Fratto Pasquale, Giuffrida Angelo Giuseppe, Glauber Mattia, Iannelli Gabriele, Iesu Severino, Livi Ugolino, Martinelli Gianluca, Massetti Massimo, Mastroroberto Pasquale, Menicanti Lorenzo, Minniti Giuseppe, Miraldi Fabio, Montesi Gianfranco, Musumeci Francesco, Nicolini Francesco, Napoleone Carlo Pace, Panisi Paolo, Pappalardo Aniello, Patanè Francesco, Ragni Temistocle, Rinaldi Mauro, Tribastone Salvatore, Triggiani Michele, Tritto Francesco Paolo, Zebele Carlo, Parolari Alessandro, Gerosa Gino, De Feo Marisa

Affiliations

¹ Department of Translational Medicine, Cardiac Surgery Unit, University of Campania, Luigi Vanvitelli, AORN dei Colli, Cardiac Surgery, Vincenzo Monaldi Hospital, Naples, Italy.
² Cardiac Anaesthesia and Intensive Care Unit, AORN Dei Colli, Monaldi Hospital, Naples, Italy.
³ Cardiology and Cardiac Surgery, API "Madonna del Ponte", Lanciano, Italy.
⁴ Cardiac Surgery Unit, Spedali Civili, Brescia, Italy.
⁵ Cardiac Surgery Unit, Azienda Ospedaliera Santa Maria, Terni, Italy.
⁶ Cardiac Surgery Unit, San Raffaele Hospital, Milan, Italy.
⁷ Cardiac Surgery Unit, Clinica Mediterranea, Naples, Italy.
⁸ Cardiac Surgery Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
⁹ Cardiac Surgery Unit, Casa di Cura San Michele, Maddaloni, Caserta, Italy.
¹⁰ Cardiac Surgery Unit, Gemelli Molise, Fondazione Giovanni Paolo II, Campobasso, Italy.
¹¹ Cardiac Surgery Unit, European Hospital, Rome, Italy.
¹² Cardiac Surgery Unit, Clinica Pineta Grande, Castel Volturno, Caserta, Italy.
¹³ Cardiac Surgery Department, Lancisi Cardiovascular Center-OORR-Polytechnic University of Marche-School of Medicine, Ancona, Italy.
¹⁴ Cardiac Surgery Unit, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy.
¹⁵ Cardiac Surgery Unit, AORNAS "San Giuseppe Moscati", Avellino, Italy.
¹⁶ Cardiac Surgery Unit, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy.
¹⁷ Cardiac Surgery Unit, AOU Policlinico-Vittorio Emanuele, Catania, Italy.
¹⁸ Cardiac Surgery Unit, Istituto Clinico Sant'Ambrogio, Milan, Italy.
¹⁹ Cardiac Surgery Unit, University of Naples Federico II, Naples, Italy.
²⁰ Cardiac Surgery Unit, A.O. San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy.
²¹ Cardiac Surgery Unit, Azienza Ospedaliero-Universitaria S. Maria della Misericordia, Udine, Italy.
²² Cardiac Surgery Unit, Clinica San Gaudenzio, Gruppo Policlinico di Monza, Novara, Italy.
²³ Cardiac Surgery Unit, Policlinico "A. Gemelli", Università Cattolica del Sacro Cuore, Rome, Italy.
²⁴ Cardiac Surgery Unit, Università degli Studi Magna Graecia, Catanzaro, Italy.
²⁵ Cardiac Surgery Unit, Centro "E. Malan", Milan, Italy.
²⁶ Cardiac Surgery Unit, Ospedale di Treviso, Treviso, Italy.
²⁷ Cardiac Surgery Unit, Università La Sapienza, Rome, Italy.
²⁸ Cardiac Surgery Unit, Università Policlinico "Le Scotte", Siena, Italy.
²⁹ Cardiac Surgery Unit, Azienda Ospedaliera San Camillo-Forlanini, Rome, Italy.
³⁰ Cardiac Surgery Unit, University of Parma, Parma, Italy.
³¹ Azienda Ospedaliera Città della Salute e della Scienza di Torino, Presidio Ospedale Infantile Regina Margherita, Torino, Italy.
³² Cardiac Surgery Unit, Humanitas Gavazzeni, Bergamo, Italy.
³³ Cardiac Surgery Unit, Ospedali Riuniti di Trieste, Italy.
³⁴ Cardiac Surgery Unit, Azienda Ospedaliera Papardo, Messina, Italy.
³⁵ Cardiac Surgery Unit, Ospedale R. Silvestrini, Perugia, Italy.
³⁶ Cardiac Surgery Unit, Azienda Ospedaliera Città della Salute e della Scienza di Torino, Presidio Molinette, Università di Torino, Torino, Italy.
³⁷ Cardiac Surgery Unit, Centro Cuore Morgagni, Pedara, Catania, Italy.
³⁸ Cardiac Surgery Unit, Ospedale Giuseppe Mazzini, Teramo, Italy.
³⁹ Cardiac Surgery Unit, AORNAS SS. Anna e Sebastiano, Caserta, Italy.
⁴⁰ Cardiac Surgery Unit, Casa di Cura Montevergine, Mercogliano (AV), Italy.
⁴¹ Department of University Cardiac Surgery and Translational Research, IRCCS Policlinico S. Donato, University of Milan, Milan, Italy.
⁴² Department of Cardiac Surgery, University of Padua, Padua, Italy.

PMID: 33657222
PMCID: PMC7989504
DOI: 10.1093/ejcts/ezaa436

Abstract

Objectives: Healthcare systems worldwide have been overburdened by the coronavirus disease 2019 (COVID-19) outbreak. Accordingly, hospitals had to implement strategies to profoundly reshape both non-COVID-19 medical care and surgical activities. Knowledge about the impact of the COVID-19 pandemic on cardiac surgery practice is pivotal. The goal of the present study was to describe the changes in cardiac surgery practices during the health emergency at the national level.

Methods: A 26-question web-enabled survey including all adult cardiac surgery units in Italy was conducted to assess how their clinical practice changed during the national lockdown. Data were compared to data from the corresponding period in 2019.

Results: All but 2 centres (94.9%) adopted specific protocols to screen patients and personnel. A significant reduction in the number of dedicated cardiac intensive care unit beds (-35.4%) and operating rooms (-29.2%), along with healthcare personnel reallocation to COVID departments (nurses -15.4%, anaesthesiologists -7.7%), was noted. Overall adult cardiac surgery volumes were dramatically reduced (1734 procedures vs 3447; P < 0.001), with a significant drop in elective procedures [580 (33.4%) vs 2420 (70.2%)].

Conclusions: This national survey found major changes in cardiac surgery practice as a response to the COVID-19 pandemic. This experience should lead to the development of permanent systems-based plans to face possible future pandemics. These data may effectively help policy decision-making in prioritizing healthcare resource reallocation during the ongoing pandemic and once the healthcare emergency is over.

Keywords: COVID-19 pandemic; Cardiac surgery; Healthcare resources; Prioritization; Waiting list.

Figures

**Figure 1:**
Proportion of centres stratified by resource reallocation to treat COVID-19.

See this image and copyright information in PMC

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References

1. Rosenbaum L. Facing Covid-19 in Italy—ethics, logistics, and therapeutics on the epidemic's front line. N Engl J Med 2020;382:1873–5. - PubMed
1. Eurostat. Healthcare Resource Statistics—Beds. https://ec.europa.eu/eurostat/statistics-explained/index.php/Healthcare_... (22 May 2020, date last accessed),
1. Vergano M, Bertolini G, Giannini A, Gristina GR, Livigni S, Mistraletti G et al. Clinical ethics recommendations for the allocation of intensive care treatments in exceptional, resource-limited circumstances: the Italian perspective during the COVID-19 epidemic. Version 2. Crit Care 2020;24:165. - PMC - PubMed
1. Giordano A, Biondi-Zoccai G, Frati G, Bartorelli AL. Management of structural heart disease and acute coronary syndromes in the COVID-19 pandemic. Curr Atheroscler Rep 2020;22:29. - PMC - PubMed
1. Pisano A, Landoni G, Zangrillo A. Protecting high-risk cardiac patients during the COVID-19 outbreak. J Cardiothorac Vasc Anesth 2020;34:1698. - PMC - PubMed

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[1] Rosenbaum L. Facing Covid-19 in Italy—ethics, logistics, and therapeutics on the epidemic's front line. N Engl J Med 2020;382:1873–5. - PubMed

[2] Rosenbaum L. Facing Covid-19 in Italy—ethics, logistics, and therapeutics on the epidemic's front line. N Engl J Med 2020;382:1873–5. - PubMed

[3] Eurostat. Healthcare Resource Statistics—Beds. https://ec.europa.eu/eurostat/statistics-explained/index.php/Healthcare_... (22 May 2020, date last accessed),

[4] Eurostat. Healthcare Resource Statistics—Beds. https://ec.europa.eu/eurostat/statistics-explained/index.php/Healthcare_... (22 May 2020, date last accessed),

[5] Vergano M, Bertolini G, Giannini A, Gristina GR, Livigni S, Mistraletti G et al. Clinical ethics recommendations for the allocation of intensive care treatments in exceptional, resource-limited circumstances: the Italian perspective during the COVID-19 epidemic. Version 2. Crit Care 2020;24:165. - PMC - PubMed

[6] Vergano M, Bertolini G, Giannini A, Gristina GR, Livigni S, Mistraletti G et al. Clinical ethics recommendations for the allocation of intensive care treatments in exceptional, resource-limited circumstances: the Italian perspective during the COVID-19 epidemic. Version 2. Crit Care 2020;24:165. - PMC - PubMed

[7] Giordano A, Biondi-Zoccai G, Frati G, Bartorelli AL. Management of structural heart disease and acute coronary syndromes in the COVID-19 pandemic. Curr Atheroscler Rep 2020;22:29. - PMC - PubMed

[8] Giordano A, Biondi-Zoccai G, Frati G, Bartorelli AL. Management of structural heart disease and acute coronary syndromes in the COVID-19 pandemic. Curr Atheroscler Rep 2020;22:29. - PMC - PubMed

[9] Pisano A, Landoni G, Zangrillo A. Protecting high-risk cardiac patients during the COVID-19 outbreak. J Cardiothorac Vasc Anesth 2020;34:1698. - PMC - PubMed

[10] Pisano A, Landoni G, Zangrillo A. Protecting high-risk cardiac patients during the COVID-19 outbreak. J Cardiothorac Vasc Anesth 2020;34:1698. - PMC - PubMed

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Cardiac surgery practice during the COVID-19 outbreak: a multicentre national survey

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Cardiac surgery practice during the COVID-19 outbreak: a multicentre national survey

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