Should I have Heart Surgery in COVID-19?
| Dr. Nikunj Pawar, Cardiac Surgeon, Prof & HOD, Nagpur - 11 Aug 2020


Time is of the essence when you have a correctable cardiac surgical disease. Since the advent of Lockdown 1 we have done approximately 60 Cardiac and Vascular surgeries with no patients turning Covid-19 positive.

By Dr Nikunj Pawar, Sr Cardiac Surgeon and Prof & HOD GMC & SSH Nagpur

Nagpur, Aug 12, 2020: “Can I have Cardiac Surgery in Covid-19 Pandemic” Asked one of my patients. I Assured him it would be safe to do so, otherwise the risk of death due to cardiac events are 10 times more than Covid-19 infection. Moreover, cardiac death is largely preventable, if patients with a heart attack come to hospital in time to get treatment.

At that early phase of pandemic data from Vienna, Austria stated that the cardiac death in Vienna had superseded the corona deaths (108 versus 87). Reasons were delay in arrival of Ambulance due to lockdown and fear of patients of contracting Corona while at Hospital, thus leading to their untimely deaths

The vast majority of hospital physicians and nurses answering the ESC (European Society of Cardiology) survey reported a drop in the number of patients with these severe heart attacks coming to hospital, compared to before the COVID-19 crisis.

On average, there was a 50% decrease.  In addition, most respondents said that of those patients who did go to hospital, 48% arrived later than usual and beyond the optimal window for urgent treatment.

Right at the beginning of the explosion of Covid pandemic in India we were asked to formulate a policy for continuing  operations in Government Medical College and Super Specialty Hospital (GMC&SSH).

The policy should safe guard the highly skilled medical staff from Corona virus and also the patients.

We wrote the policy and protocols so that critical patients continued to get cardiac surgery services and we employed it at the government hospital and my private practice.

Most essential aspect was education of the doctors, OT and ICU staff regarding the transmission of the disease process and measures for self and patient protection. The requisite change were implemented in the existing protocols to safe guard patient and staff safety.

We have implemented a new normal, with numerous protocols that allow both our patients and our healthcare personnel to remain safe and take comfort in proceeding with the care that can no longer be put off.

Critical here was screening all the hospital staff entering the hospital for temperature and history of cough and fever. Staff were encouraged to inform by phone if any such symptoms , stay at home till symptoms settle. Hand hygieneprocedures, personal protection and social distancing were strictly adhered to.

For the protection of everyone, we are testing all patients that are having cardiac surgery for COVID-19 prior to the date of their procedure, as well as all people involved.

Our anesthesia team takes special precautions when intubating our patients. Our entire operating room team wears additional personal protective equipment.

This is all done in addition to testing our patients for COVID-19. A negative test is required before entering the hospital for elective surgery.

We are currently not allowing our patients to be accompanied by family members. While this may seem frustrating, it is a necessary precaution we must take at this time in order to protect our patients and our healthcare workers who risk their lives daily to care for patients in need.

The less exposure to others that we and our patients have, the safer our environment is for everyone.

A patient can also rest assured that we have implemented an impressive communication system. We keep each patient’s family informed throughout the operation, and I personally meet the family after the surgery.

When the patient arrives in the Cardiac Surgical ICU, the intensivist also meets one family member. Later in the afternoon/evening, the ICU nurse and the cardiac nurse practitioner once again call the family where they are provided with a phone number to call the ICU.

Once the patient is extubated, which is usually one to four hours after arrival to the ICU, staff assists the patient in actually seeing their family members via video calling.

Patient safety is our number one priority.

It is crucial to proceed with heart surgery once indicated. We all have fears during these unprecedented times, but developing COVID-19 in addition to existing cardiac disease will lead to poor outcomes.

Time is of the essence when you have a correctable cardiac surgical disease. Since the advent of Lockdown 1 we have done approximately 60 Cardiac and Vascular surgeries with no patients turning Covid-19 positive.

Your heart may not wait until the pandemic is over.

I encourage patients and families NOT to be concernedwhen proceeding with heart surgery, even during the pandemic, as long as hospitals prepare themselves accordingly and deliver exactly the same results and outcomes as before.

Place your heart in our hands, and we will get you through this.

Image credit - India Times

(Dr. Nikunj Pawar is a well known name in the cardiac surgery in India having done over 4000 heart surgeries in last two decades; Worked at Royal Hospital, Muscat, Sultanate of Oman, as a Specialist Cardiac Surgeon and subsequently in New Zealand and then at Royal Melbourne Hospital, Melbourne Australia for five years as a Senior Registrar; MBBS, MS, MCh (CTVS), FICS (USA), Fellow: Royal Melbourne Hospital and Wellington Hospital, Consultant Cardiothoracic and Vascular Surgery & Director – CVTS; Presently working as Senior Consultant Cardiac Surgeon and Prof & HOD GMC & SSH Nagpur, Maharashtra which is the only government unit working and doing cardiac surgery in the state. The views expressed are his personal.) 

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