Balmforth Damian, Yates Martin T, Lau Kelvin, Hussain Azhar, Lopez-Marco Ana, Edmondson Stephen, Oo Aung, Uppal Rakesh
Department of Cardiothoracic Surgery, St Bartholomew's Hospital, London, United Kingdom.
Queen Mary University of London, London, United Kingdom.
JTCVS Open. 2020 Dec;4:107-114. doi: 10.1016/j.xjon.2020.09.003. Epub 2020 Sep 23.
In the United Kingdom, the coronavirus disease 2019 (COVID-19) pandemic has led to the cessation of elective surgery. However, there remains a need to provide urgent and emergency cardiac and thoracic surgery as well as to continue time-critical thoracic cancer surgery. This study describes our early experience of implementing a protocol to safely deliver major cardiac and thoracic surgery in the midst of the pandemic.
Data on all patients undergoing cardiothoracic surgery at a single tertiary referral center in London were prospectively collated during the first 7 weeks of lockdown in the United Kingdom. A comprehensive protocol was implemented to maintain a COVID-19-free environment including the preoperative screening of all patients, the use of full personal protective equipment in areas with aerosol-generating procedures, and separate treatment pathways for patients with and without the virus.
A total of 156 patients underwent major cardiac and thoracic surgery over the study period. Operative mortality was 9% in the cardiac patients and 1.4% in thoracic patients. The preoperative COVID-19 protocol implemented resulted in 18 patients testing positive for COVID-19 infection and 13 patients having their surgery delayed. No patients who were negative for COVID-19 infection on preoperative screening tested positive postoperatively. However, 1 thoracic patient tested positive on intraoperative bronchoalveolar lavage.
Our early experience demonstrates that it is possible to perform major cardiac and thoracic surgery with low operative mortality and zero development of postoperative COVID-19 infection.
在英国，2019年冠状病毒病（COVID-19）大流行导致择期手术停止。然而，仍有必要提供紧急心脏和胸外科手术，以及继续进行对时间要求严格的胸段癌症手术。本研究描述了我们在大流行期间实施一项协议以安全开展心脏和胸外科大手术的早期经验。
在英国封锁的前7周，前瞻性收集了伦敦一家三级转诊中心所有接受心胸外科手术患者的数据。实施了一项全面协议以维持无COVID-19的环境，包括对所有患者进行术前筛查，在进行产生气溶胶操作的区域使用全套个人防护装备，以及为感染病毒和未感染病毒的患者设置不同的治疗途径。
在研究期间，共有156例患者接受了心脏和胸外科大手术。心脏手术患者的手术死亡率为9%，胸科手术患者为1.4%。实施的术前COVID-19协议导致18例患者COVID-19感染检测呈阳性，13例患者手术延迟。术前筛查COVID-19感染呈阴性的患者术后均未检测呈阳性。然而，1例胸科患者术中支气管肺泡灌洗检测呈阳性。
我们早期的经验表明，在手术死亡率较低且术后无COVID-19感染发生的情况下进行心脏和胸外科大手术是可行的。
