University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom.
South Tees Hospitals NHS Trust, Middlesbrough, United Kingdom.
J Thorac Cardiovasc Surg. 2020 Oct;160(4):968-973. doi: 10.1016/j.jtcvs.2020.05.016. Epub 2020 May 19.
No firm recommendations are currently available to guide decision making for patients requiring cardiac surgery during the coronavirus disease 2019 (COVID-19) pandemic. Systematic appraisal of senior surgeons' consensus can be used to generate interim recommendations until data from clinical observations become available. Hence, we aimed to collect and quantitatively appraise nationwide UK consultants' opinions on clinical decision making for patients requiring cardiac surgery during the COVID-19 pandemic.
We E-mailed a Web-based questionnaire to all consultant cardiac surgeons through the Society for Cardiothoracic Surgery in Great Britain and Ireland mailing list on the April 17, 2020, and we predetermined to close the survey on the April 21, 2020. This survey was primarily designed to gather information on UK surgeons' opinions using 12 items. Strong consensus was predefined as an opinion shared by at least 60% of responding consultants.
A total of 86 consultant surgeons undertook the survey. All UK cardiac units were represented by at least 1 consultant. Strong consensus was achieved for the following key questions: (1) before any hospital admission for cardiac surgery, nasopharyngeal swab, polymerase chain reaction, and computed tomography of the chest should be performed; (2) the use of full personal protective equipment should to be adopted in every case by the theater team regardless of the patient's COVID-19 status; (3) the risk of COVID-19 exposure for patients undergoing heart surgery should be considered moderate to high and likely to increase mortality if it occurs; and (4) cardiac procedures should be decided based on a rapidly convened multidisciplinary team discussion for every patient. The majority believed that both aortic and mitral surgery should be considered in selected cases. The role of coronary artery bypass graft surgery during the pandemic was controversial.
In this unprecedented pandemic period, this survey provides information for generating interim recommendations until data from clinical observations become available.
目前尚无明确建议可用于指导在新冠疫情期间需要接受心脏手术的患者的决策。系统评估资深外科医生的共识可以用来生成临时建议，直到有临床观察数据可用。因此，我们旨在收集和定量评估英国全国顾问对新冠疫情期间需要接受心脏手术的患者的临床决策的意见。
我们于 2020 年 4 月 17 日通过英国胸心外科学会的电子邮件向所有顾问心脏外科医师发送了一份基于网络的问卷，并预定于 2020 年 4 月 21 日关闭调查。该调查主要用于使用 12 个项目收集有关英国外科医生意见的信息。强共识定义为至少 60%的回复顾问共享的意见。
共有 86 名顾问外科医师参与了调查。英国的所有心脏科单位都至少有 1 名顾问。对于以下关键问题达成了强烈共识：（1）在进行任何心脏手术的住院前，都应进行鼻咽拭子、聚合酶链反应和胸部计算机断层扫描；（2）无论患者的 COVID-19 状态如何，手术团队都应采用全套个人防护设备；（3）接受心脏手术的患者感染 COVID-19 的风险应被认为是中高度的，如果发生，可能会增加死亡率；（4）应根据每个患者的快速召集的多学科团队讨论来决定心脏手术。大多数人认为，在选定的病例中应考虑主动脉瓣和二尖瓣手术。在大流行期间，冠状动脉旁路移植术的作用存在争议。
在这个前所未有的大流行期间，该调查为在有临床观察数据可用之前生成临时建议提供了信息。
