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• W3048370399 abstract "Dr Arora holds an unrestricted educational grant from Pfizer Canada, Inc, and Honoraria from Mallinckrodt Pharmaceuticals, Abbott Nutrition, and Edwards Lifesciences unrelated to the present communication. All other authors reported no conflicts of interest.The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest. Dr Arora holds an unrestricted educational grant from Pfizer Canada, Inc, and Honoraria from Mallinckrodt Pharmaceuticals, Abbott Nutrition, and Edwards Lifesciences unrelated to the present communication. All other authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest. In their letter to the editor,1Maj G. Campanella A. Audob A. The importance of COVID-19 testing in cardiac surgery.J Thorac Cardiovasc Surg. 2020; 160: e149Abstract Full Text Full Text PDF Scopus (3) Google Scholar Maj and colleagues cited the recently published guidance document on cardiac surgical triaging during the coronavirus 2019 (COVID-19) pandemic by Haft and colleagues2Haft J.W. Atluri P. Alawadi G. Engelman D. Grant M.C. Hassan A. et al.Adult cardiac surgery during the COVID-19 pandemic: a tiered patient triage guidance statement.Ann Thorac Surg. April 10, 2020; ([Epub ahead of print])Google Scholar and raised the following points: (1) the absence of patient frailty as part of the triaging process, (2) the potential collateral impact of deferring patients on the cardiac surgery wait list during the pandemic, and (3) the value of routine preoperative COVID-19 testing in protecting both patients and health care workers. First, frailty is a well-established risk factor for increased morbidity and mortality following cardiac surgery.3Sepehri A. Beggs T. Hassan A. Rigatto C. Shaw-Daigle C. Tangri N. et al.The impact of frailty on outcomes after cardiac surgery: a systematic review.J Thorac Cardiovasc Surg. 2014; 148: 3110-3117Abstract Full Text Full Text PDF PubMed Scopus (293) Google Scholar The recently-published National Institute for Health and Care Excellence (NICE) guidelines have incorporated a measure of frailty to guide clinical decisions in critically ill adults.4National Institute of Health and Care ExcellenceOverview | COVID-19 rapid guideline: critical care in adults | Guidance | NICE. 2020.https://www.nice.org.uk/guidance/ng159Google Scholar We acknowledge that frail patients are likely at increased risk for contracting COVID-19 (with an as of yet-to-be determined impact on outcomes) and that frailty should be considered when triaging patients both during the surgical deferral phase of the pandemic and as part of the “ramping back up” phase when the COVID-19 curves begin to flatten.5Hassan A. Arora R.C. Lother S.A. Adams C. Bouchard D. Cook R. et al.Ramping up the delivery of cardiac surgery during the COVID-19 pandemic: a guidance statement from the Canadian Society of Cardiac Surgeons.Can J Cardiol. April 29, 2020; ([Epub ahead of print])Google Scholar Second, delay in definitive therapy for certain cardiovascular diseases may yield major adverse cardiac consequences, including myocardial infarction, decline in ventricular function, or sudden death. As such, we must re-emphasize that for those patients in whom procedures are being delayed and in whom alternative therapies are not deemed appropriate, there is a critical need to proactively monitor every patient on the surgical wait-list for progression of symptoms.2Haft J.W. Atluri P. Alawadi G. Engelman D. Grant M.C. Hassan A. et al.Adult cardiac surgery during the COVID-19 pandemic: a tiered patient triage guidance statement.Ann Thorac Surg. April 10, 2020; ([Epub ahead of print])Google Scholar Finally, we are saddened by Maj and colleagues' accounts of COVID-19 infection at their institution, first in those patients with advanced cardiovascular disease who, despite not having viral symptoms on admission, eventually tested positive for COVID-19, and second, among the cardiac surgeons, cardiac anesthesiologists, and nurses who tested positive while serving on the frontlines. Many have advocated for routine testing in an effort to mitigate the risk of COVID-19 infection and transmission, but there remains, at present, NO test available that can reliably rule out COVID-19, particularly in the asymptomatic patient.5Hassan A. Arora R.C. Lother S.A. Adams C. Bouchard D. Cook R. et al.Ramping up the delivery of cardiac surgery during the COVID-19 pandemic: a guidance statement from the Canadian Society of Cardiac Surgeons.Can J Cardiol. April 29, 2020; ([Epub ahead of print])Google Scholar Rather, testing must be complemented by well-established risk-reduction strategies, including frequent screening, handwashing, physical distancing, use of personal protective equipment, and isolation of those at risk. Only then will hospitals be able to provide a safe environment for their patients and their health care providers in the “post-lockdown, pre-vaccine” phase of the pandemic.6Engelman D.T. Lother S. George I. Funk D.J. Ailawadi G. Atluri P. et al.Adult cardiac surgery and the COVID-19 pandemic: aggressive infection mitigation strategies are necessary in the operating room and surgical recovery.Ann Thorac Surg. April 27, 2020; ([Epub ahead of print])Google Scholar Cardiac surgeons from across the world have drastically changed their clinical practices in response to the COVID-19 pandemic, and while published guidance statements have provided a template by which these changes could be carried out, they have not always accounted for the differences that often exist between institutions, regions, and countries. The letter by Maj and colleagues highlights the realities that some of us face, and it is up to the global cardiac surgical community to share knowledge, experiences, and collect data to determine best practices so that we may care for our patients and for each other to the best of our abilities. The authors acknowledge the contribution of all the members of the Society of Thoracic Surgeons COVID-19 Taskforce to this document (in alphabetical order): Gorav Ailawadi, MD, Pawan Atluri, MD, Daniel T. Engelman, MD, Michael C. Grant, MD, Isaac George, MD, Jean- Francois Legare, MD MSc, Sylvain Lother, MD, and Glenn Whitman. The importance of Coronavirus Disease 2019 testing in cardiac surgeryThe Journal of Thoracic and Cardiovascular SurgeryVol. 160Issue 3PreviewThe extraordinary demands for managing patients with Coronavirus Disease 2019 (COVID-19) has altered the Italian hospitals' ability to provide adequate care. With exponential increase of the COVID-19 population and a progressive reduction of resources, the ability to provide surgical care has been rapidly decreased.1 Although several surgical organizations developed guides for triaging patents with cancer, the selection of candidates for cardiac surgery poses major challenges given the rapid progression of the underlying disease and the uncertain evolution of organ failure. Full-Text PDF Open Archive" @default.
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