Background

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.

Methods

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.

Results

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.

Conclusions

In this unprecedented pandemic period, this survey provides information for generating interim recommendations until data from clinical observations become available.

中文翻译：

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一项关于英国心脏外科医生在 2019 年冠状病毒病 (COVID-19) 大流行期间对临床决策的看法的全国性调查。

背景

目前没有明确的建议可用于指导在 2019 年冠状病毒病 (COVID-19) 大流行期间需要心脏手术的患者的决策。高级外科医生共识的系统评估可用于生成临时建议，直到临床观察数据可用。因此，我们旨在收集和定量评估英国全国顾问对 COVID-19 大流行期间需要心脏手术的患者的临床决策的意见。

方法

我们于 2020 年 4 月 17 日通过英国和爱尔兰心胸外科协会邮寄名单向所有心脏外科医生顾问发送了一份基于网络的调查问卷，我们预定在 2020 年 4 月 21 日结束调查。本调查主要旨在使用 12 个项目收集有关英国外科医生意见的信息。强烈的共识被预先定义为至少 60% 的响应顾问共享的意见。

结果

共有 86 名顾问外科医生进行了调查。所有英国心脏单位均由至少 1 名顾问代表。在以下关键问题上达成了强烈共识：（1）在心脏手术入院前，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，战区团队在每种情况下都应采用完整的个人防护设备；(3) 接受心脏手术的患者暴露于 COVID-19 的风险应被认为是中度至高度，并且如果发生可能会增加死亡率；(4) 心脏手术应根据为每位患者迅速召集的多学科团队讨论决定。大多数人认为在选定的病例中应同时考虑主动脉和二尖瓣手术。在大流行期间冠状动脉搭桥手术的作用是有争议的。

结论

在这个史无前例的大流行时期，这项调查提供了生成临时建议的信息，直到临床观察数据可用。