September 18, 2020 by John Fernandez
Don’t Delay Your Heart Surgery in COVID-19 Era
As much as most people wish it were true, heart disease doesn’t just disappear. Ignoring symptoms, avoiding the doctor or delaying treatment can have dire consequences.
It’s not just the emergency cases that worry Joseph McGinn Jr., M.D., the new chief of cardiac surgery at Miami Cardiac & Vascular Institute, although those do concern him. But as the country moves toward a cautious reopening and more surgeries are scheduled, he says it’s time for patients to resume treatment for heart disease and schedule any cardiac procedures that might have been delayed because of the COVID-19 pandemic.
“The reality is we do these surgeries because we know that it enables people to live longer and avoid heart attacks and other problems,” says Dr. McGinn, who is renown internationally for pioneering minimally invasive cardiac bypass surgery.
“The message to the public is you need to get back to taking care of your medical issues because if not, elective things will become urgent, and then urgent things will become emergent. Any time you upgrade to urgent or emergent, the risk gets higher and the surgery becomes more difficult,” he says. “I am worried that if people delay their care, we will have some bad outcomes.”
While Dr. McGinn understands some patients may be nervous about seeking treatment because of the coronavirus, they put themselves at far greater risk by ignoring cardiac symptoms than by visiting a medical facility, especially considering all the safety measures adopted to minimize the chance of exposure.
Baptist Health has always worked hard to provide the most pristine environment for patients and staff, but “This is like nothing like I’ve ever seen. Everything is being cleaned constantly, disinfected with chemicals. It is way, way beyond what we’ve done before,” he says. Plus he adds, anyone who might have COVID-19 is segregated from other patients. “Those patients go into an area of the hospital which 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 heart surgery patients are — not even close.”
Throughout the pandemic, the Institute has remained open for the most critically ill patients and for emergencies. Nationwide, however, CDC guidelines required elective surgeries to be put on hold in mid-March to ensure hospital systems weren’t overwhelmed. Now, three months later, the restrictions have eased, but patients have barely begun to trickle back in, Dr. McGinn says.
Part of the problem may be confusion over the term “elective.” In the context of cardiac surgery, it reflects how critical a situation is, Dr. McGinn explains. “We put cases into three categories: elective, urgent and emergent. About half of the coronary cases are either urgent or emergent. They must be treated immediately. The other half are elective and can be scheduled,” he says. Many other surgeries, such as valve replacements and aortic repairs, also may be considered elective. “Some of these patients are followed medically for years before they have a procedure.”
That doesn’t mean the elective cases don’t require intervention, only that it can be scheduled. “Their disease still exists; they are going to need surgery eventually,” he says, adding he is troubled by the number of patients who are staying away. “We don’t know where all the elective cases have gone — patients are either afraid to come in or they are dying at home. We don’t know what has happened to them.”
Many people already have a tendency to disregard their symptoms, whether out of fear, lack of understanding or because they are in denial. “More than 30 percent of people learn they have coronary artery disease when they have their first heart attack and die suddenly,” Dr. McGinn says. Heart attacks are the leading cause of death for both men and women in America.
Even among patients with mild symptoms who don’t require emergency bypass surgery or stenting, Dr. McGinn doesn’t like long delays. Cases that would benefit from preventive care can become emergencies. “Heart attacks can happen at any time. If a patient has minimal symptoms, they can wait a week, two weeks, maybe three weeks to get their surgery. But I don’t like waiting more than three weeks because you never know what’s going to happen,” he says. “So we’re now three months later and all these people still haven’t come in. We know they will end up in here sooner or later. Sooner would be better.”
One positive aspect 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 minimally invasive cardiac bypass surgery, a procedure he says is done routinely in only a handful of hospitals in the United States. The surgery, known internationally as the McGinn Technique, does not require the chest to be opened or the heart to be stopped.
“We had plenty of time to do rehearsal dry runs, to do educational sessions with the surgical team, and to get the recovery teams ready to manage these patients after the surgery,” he says. “We did several minimally invasive coronary bypass cases during the period of COVID and the patients did very well because the teams were very well prepared. We ended up having excellent results.”