Impact of COVID-19 Lockdown on Adult Cardiac Surgery in a Public Hospital

Objectives: In 2019 the coronavirus SARS-CoV-2 began to spread rapidly. According to the World Health Organization 25 million COVID-19 cases were confirmed globally with over 850,000 deaths. To contain the pandemic Bavaria introduced a lockdown in 20.03.2020. To avoid further morbidity and mortality preclinical facilities with diagnostic tools, triage protocols and supplementary isolated intensive care units focused on corona related patients.

These measures led to a reduction of medical resources for other patients. Also elective cardiac surgery (CS) and diagnosis was delayed and reduced leading to more patients with progressive cardiac symptoms. These patients were transported or transferred to our hospital needing urgent cardiac surgery procedure.

In this study we aim to report the variation of incidences, emergency cases and cardiac symptoms after lockdown and compare these numbers to an equal period in 2019.

Methods: We compared a cohort after lockdown in 20.03–14.08.2020 with a cohort in an equal period in 2019. Classification parameters according to the New York Heart Association (NYHA), the Canadian Cardiovascular Society (CCS), the American Society of Anesthesiologists (ASA) and the history of myocardial infarction/cardiac decompensation were observed. Also a 30 days follow up was performed.

Result: Compared with 2019, a decline of incidence in cardiac surgery procedures was observed after lockdown by −20.81% (p < 0.01). Coronary artery bypass grafting (CABG) procedures went down by −51.28%, heart valve disease (HVD) went down by −4.17%, CABG + HVD increased by +10.81%, aortic −15%, and others −46.67%.

Moreover, significant increases in high-level NYHA, CCS, cardiac shock, and ASA could be observed: NYHA (III from 39.08 to 56.30% and IV: 5.75–7.78%), CCS (IV: 2.02–6.69%), and cardiac shock/decompensation (17.52–19.33%). Accordingly, an elevated grade of ASA indicating urgent CS was derived (IV: 37.07–51.48% and V: 1.72–8.52%).

A 30-day follow-up showed no significant difference concerning overall mortality in 2019 (3.33%) versus 2020 (3.74%)—the cause of death being cardiac failure (nine cases in 2019; two cases in 2020) and multiorgan failure (two cases in 2019; five cases in 2020).

Conclusion: Due to the pandemic preclinical diagnostics and therapy put a strong focus on corona related patients. The reduction and postponement of elective cardiac procedures led to a higher number of patients with progressive cardiac symptoms in need for urgent CS procedures.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
19 February 2021