Don’t Delay Your Heart Surgery in COVID-19 Era

As much as mostpeople wish it were true, heart disease doesn’t just disappear. Ignoringsymptoms, avoiding the doctor or delaying treatment can have dire consequences.

It’s not just theemergency cases that worry JosephMcGinn Jr., M.D., the new chief of cardiac surgery at Miami Cardiac & Vascular Institute, althoughthose do concern him. But as the country moves toward a cautious reopening and moresurgeries are scheduled, he says it’s time for patients to resume treatment forheart disease and schedule any cardiac procedures that might have been delayedbecause of the COVID-19 pandemic.

“The reality is wedo these surgeries because we know that it enables people to live longer andavoid heart attacks and other problems,” says Dr. McGinn, who is renown internationallyfor pioneering minimallyinvasive cardiac bypass surgery.

“The message tothe public is you need to get back to taking care of your medical issuesbecause if not, elective things will become urgent, and then urgent things willbecome emergent. Any time you upgrade to urgent or emergent, the risk getshigher and the surgery becomes more difficult,” he says. “I am worried that ifpeople delay their care, we will have some bad outcomes.”

While Dr. McGinn understandssome patients may be nervous about seeking treatment because of the coronavirus,they put themselves at far greater risk by ignoring cardiac symptoms than byvisiting a medical facility, especially considering all the safety measuresadopted to minimize the chance of exposure.

Baptist Health hasalways worked hard to provide the most pristine environment for patients andstaff, but “This is like nothing like I’ve ever seen. Everything is beingcleaned constantly, disinfected with chemicals. It is way, way beyond whatwe’ve done before,” he says. Plus he adds, anyone who might have COVID-19 issegregated from other patients. “Those patients go into an area of the hospitalwhich is away — quite a bit away — from where the routine stuff is happening.Patients who have COVID, or suspected COVID, are nowhere near where the heartsurgery patients are — not even close.”

Throughout thepandemic, the Institute has remained open for the most critically ill patients andfor emergencies. Nationwide, however, CDC guidelines required electivesurgeries to be put on hold in mid-March to ensure hospital systems weren’toverwhelmed. Now, three months later, the restrictions have eased, but patientshave barely begun to trickle back in, Dr. McGinn says.

Part of theproblem may be confusion over the term “elective.” In the context of cardiacsurgery, it reflects how critical a situation is, Dr. McGinn explains. “We putcases into three categories: elective, urgent and emergent. About half of thecoronary cases are either urgent or emergent. They must be treated immediately.The other half are elective and can be scheduled,” he says. Many othersurgeries, such as valve replacements and aortic repairs, also may beconsidered elective. “Some of these patients are followed medically for yearsbefore they have a procedure.”

That doesn’t meanthe elective cases don’t require intervention, only that it can be scheduled.“Their disease still exists; they are going to need surgery eventually,” hesays, adding he is troubled by the number of patients who are staying away. “Wedon’t know where all the elective cases have gone — patients are either afraidto come in or they are dying at home. We don’t know what has happened to them.”

Many peoplealready have a tendency to disregard their symptoms, whether out of fear, lackof understanding or because they are in denial. “More than 30 percent of peoplelearn they have coronary artery disease when they have their first heart attackand die suddenly,” Dr. McGinn says. Heart attacks are the leading cause ofdeath for both men and women in America.

Even amongpatients with mild symptoms who don’t require emergency bypass surgery or stenting,Dr. McGinn doesn’t like long delays. Cases that would benefit from preventivecare can become emergencies. “Heart attacks can happen at any time. If apatient has minimal symptoms, they can wait a week, two weeks, maybe threeweeks to get their surgery. But I don’t like waiting more than three weeksbecause you never know what’s going to happen,” he says. “So we’re now threemonths later and all these people still haven’t come in. We know they will endup in here sooner or later. Sooner would be better.”

One positiveaspect of the slowdown in surgeries during the pandemic is it gave time for Dr.McGinn, who came to the Institute in February, to prepare his team to perform minimallyinvasive cardiac bypass surgery, a procedure he says is done routinely in onlya handful of hospitals in the United States. The surgery, known internationallyas the McGinnTechnique, does not require the chest to be opened or the heart to bestopped.

“We had plenty oftime to do rehearsal dry runs, to do educational sessions with the surgicalteam, and to get the recovery teams ready to manage these patients after thesurgery,” he says. “We did several minimally invasive coronary bypass casesduring the period of COVID and the patients did very well because the teamswere very well prepared. We ended up having excellent results.”