Background and aims: The COVID-19 pandemic caused a dramatic shift in the provision of cardiac surgical services in the United Kingdom (UK) with all elective surgery suspended. We sought to explore referral patterns, changes in clinical decision making and resource allocation to adult cardiac surgical services in the UK during the first wave of the pandemic. Methods: Data from 11 UK centres on referrals and available health resources (operating theatre and bed capacity) for urgent or emergency adult cardiac surgery between the 1st March 2020 and the 1st August 2020 was collated, and securely transferred to the lead centre for analysis. Results: 1113 patients were referred for cardiac surgery over the study period. Following UK lockdown in March 2020 the number of referrals initially fell to 39% of pre-lockdown levels before recovering to 211% of that seen prior to the pandemic. A change in treatment strategies was observed with a trend towards deferring surgery entirely or favouring less invasive, non-surgical treatments. At the peak of the pandemic in April 2020, theatre availability and bed capacity fell to 26% and 54% of pre-lockdown levels, respectively. Provision for emergency surgery was maintained throughout at 1 to 2 emergency lists per unit weekly. Conclusion: During the first wave of the UK COVID-19 pandemic cardiac surgical operative activity dropped acutely before increasing over the next four months. Despite this drop, provision for emergency surgery was retained throughout. In the event of further waves of COVID-19 pandemic, maintaining essential cardiac surgical services should be prioritised.

OBJECTIVE To compare postoperative and long-term results (angina, myocardial and cerebrovascular events and coronary re-intervention) using single versus bilateral internal mammary arteries (SIMA vs. BIMA) in the setting of off-pump revascularisation (OPCAB) within a single-surgeon practice. METHODS Retrospective analysis of all isolated OPCAB performed in our institution by a single surgeon in the last 12 years.Two groups were analysed: SIMA (n = 681) and BIMA (n = 342). A propensity score matching was performed to compare the groups, reducing the sample to 684 patients.Follow-up (mean 6.5 ± 3.5 years) was done by telephone interviews or clinical visits, registering also late mortality and coronary re-intervention. Outcomes were compared to literature. RESULTS Demographic characteristics differed between groups, with BIMA offered predominantly to non-diabetic younger males (mean 59.4 years) with less comorbidity. In-hospital mortality was 2% for the SIMA group and 1% for BIMA (p = 0.18). Long-term mortality was also higher for the SIMA group (2% vs. 1% at 1 year, p = 0.22 and 16% vs. 5% at 5 years, p < 0.001). Sternal wound infection was similar in both groups (2-3%). Long-term follow-up revealed good freedom from angina (94%) with low rates of neurological and myocardial events (3%) or need for repeated revascularisation (3%) in both groups. CONCLUSION BIMA offers long-term survival benefit with similar postoperative complications. Rates of deep sternal wound infection were comparable between the two groups.Excellent outcomes can be achieved with OPCAB BIMA in real world practice with adequate patient selection.

Surgery in patients diagnosed with COVID-19 infection carries significant mortality and morbidity but the appropriate waiting period before surgical intervention after recovering from COVID-19 is not known. We analysed the outcomes of patients who underwent cardiac surgery after having been diagnosed of COVID-19 on pre-operative screening between March and July 2020. Depending on the clinical urgency we delayed surgery until negative testing and/or radiological clearance or postponed the operation where possible. As a result of waiting until COVID-19 resolution, all of our patients survived surgery without complications.

OBJECTIVES Surgery in COVID-19 patients carries a significant mortality and morbidity but the appropriate waiting period before a surgical intervention after recovering from COVID-19 is not known. We aim to determine the safety of deferring urgent surgery and to identify the earliest safe period for surgery by analysing our experience in patients who underwent cardiac surgery after recovering from COVID-19. METHODS Analysis of all patients undergoing cardiac surgery in our centre during March and April 2020, focusing in those who tested positive for COVID-19 in the pre-operative screening. RESULTS Four patients tested positive for COVID-19 during the preoperative screening. Two of them also showed radiological signs of COVID-19 lung disease. We delayed surgery until they tested negative and the radiological changes improved. None of the patients suffered a deterioration of their cardiac symptoms that mandated expediting the surgeries. As a result of waiting until COVID-19 resolution, all our patients survived the urgent cardiac surgery without developing any COVID-19-related complications. CONCLUSIONS From our experience, defering urgent cardiac surgery in patients with confirmed COVID-19 is safe. Operating as early as 4 days after a negative swab does not increase mortality and morbidity.