The unexpected consequences of the COVID-19 pandemic have thrown normal life out of gear with no immediate end in sight. Amidst the crisis across the world, cardiac surgery as a life-saving procedure cannot be deferred, especially in critical cases. Under certain restrictions, patients who need to undergo cardiac surgery need to strictly follow all recommendations and instructions advised by their cardiothoracic surgeons, enabling the most effective surgical outcomes. Considering patients with cardiovascular diseases are more likely to develop severe illness with greater mortality rates if they become infected with COVID-19, preventive measures to minimize the risk of infections must be complied with.  

Patients with cardiovascular diseases and COVID-19

Despite the fact that COVID-19 can strike people of all ages, a number of medical studies have shown that patients who have certain underlying diseases including cardiovascular conditions are at greater risk of developing a severe form of COVID-19 if they become infected, resulting in the increased risks of death. Current statistical data have pointed out that mortality rates caused by COVID-19 can rise up to 20% in patients with cardiac diseases. As the COVID-19 infections severely progress, the use of mechanical ventilation in the intensive care units increases in company with a prolonged hospitalization and an increased risk of other serious complications. 

Not only patients with underlying conditions, to control endemic spread of COVID-19, awareness in reducing disease transmission must be raised among all people. Preventive measures against COVID-19 infections include:  

1. Refraining from crowded places. Visiting congested places should be strictly avoided. If necessary, exposure time must be as short as possible. Wearing masks and frequent hand wash are crucial.
2. Wearing a face mask at all times while in public. Face masks are mandatory outdoors and indoors, especially when living in the same house with people who expose to the infections.
3. Frequent handwashing. To keep the hands clean, it is recommended to often wash your hands using soap and water or alcohol-based hand sanitizer. Alcohol spray containing at least 60% alcohol can be used to clean and disinfect hard surfaces. Electronic payment and transaction can be considered instead of cash spending.   
4. Keeping social distancing. Staying away from others can significantly reduce an individual’s chances of contracting COVID-19. Social distancing must apply to all activities, including while working and eating. Other good hygiene practices should be also followed.
5. Using separate toilets. Since the viruses can be excreted via stool, covering the toilet lid while flushing is definitely essential in order to reduce the transmission of viruses in the air. It is ideal to separate toilets for patients with cardiovascular diseases. To properly clean the toilets, toilet disinfectants and alcohol-based solution must be regularly used with caution. 

Besides patients themselves, relatives and caretakers at home or in a non-healthcare setting must remain healthy while watching for signs or symptoms of COVID-19. If warning signs exhibit, seek emergency medical care immediately.

Hospital visit during the COVID-19 pandemic 

Given that patients with cardiovascular diseases are likely to be more susceptible to severe infections, during the pandemic of COVID-19, all medications must be strictly taken as prescribed. In addition, all follow-up appointments should be completed, enabling the cardiologist and/or cardiothoracic surgeon to closely monitor treatment outcomes and disease progression as well as safety related to prescribed medications. In case that the condition seems to be uncontrolled or extensively progresses, appropriate treatment plan can be further adjusted accordingly. Apart from taking medications as directed, risk factors contributing to the exacerbation of the existing condition must be also modified. While visiting hospital for follow-ups, patients are advised to wear a face mask at all times, keep social distancing, wash hands frequently and limit time spent at the hospital. 

Adhering to the international standard of care and safety precaution, at Bangkok Heart Hospital, treatments and services are provided by highly specialized multidisciplinary teams supported by cutting-edge technology, ensuring the highest degree of effectiveness and safety. Hygienic emphasis is placed upon the cleanliness across the hospital, e.g. service counters, operating rooms, examination rooms, medical equipment and devices as well as waiting areas and high-touch surfaces. More importantly, our medical staff are compulsorily required to get a regular COVID-19 testing in order to maximize the safety degree while providing care and services. Before entering the hospital, preventive screening includes temperature measurement and personal history taking concerning the risk of COVID-19 exposure. If patients pose risks of COVID-19 infection or present with abnormal signs or symptoms potentially indicating COVID-19, services and care will be separately provided in designated areas to prevent possible transmission to others. 

Cardiac surgery during the COVID-19 pandemic 

As advised by authorized healthcare organization supported by expert opinions, most of elective surgery cases should be temporarily suspended, unless stated otherwise. The rationale to defer elective cardiac surgical procedures might involve safety and utilization of medical facilities. Nevertheless, urgent and emergency cardiac surgeries can be carried on as long as those cardiac conditions meet surgery criteria during the pandemic time. These procedures often include coronary bypass surgery, heart valve repair or replacement surgery and aortic aneurysm surgery. Whether to conduct cardiac surgery in each patient, it entirely hinges on cardiothoracic surgeon’s consideration with respect to emergency degree, disease progression and risks versus benefits of surgery. 

In case that cardiac surgery is indicated, patients and their caretakers are mandatorily required to screen for SARS‑CoV‑2 and their results should be negative (non-detected) within 72 hours prior to cardiac surgery. Nonetheless, for critical cases who need to undergo emergency cardiac surgery in which waiting for testing result of SARS‑CoV‑2 is not applicable or patients who are confirmed with COVID-19, cardiac surgery can be performed under strict universal respiratory and transmission-based precautions. 

However, the suspension of elective surgery in patients presenting with moderate symptoms or well-controlled condition can last 3 up to 6 months, or until the pandemic situation considerably resolves putting patients at ease. Besides abiding by preventive measures, all medications and instructions must be taken as directed. If any abnormal signs and symptoms arise, medical attention must be sought immediately.