Table 1.

Summary of Recommendations for Resuming Cardiac Surgery in the SARS-CoV-2 Era

Recommendation	Class of Recommendation	Level of Evidence	Relevant Society Recommendation
Restarting cardiac surgery in SARS-CoV-2 era
The cardiovascular service line, including cardiac surgery, should be among the first clinical services supported to resume elective inpatient and outpatient care as soon as critical care capacity becomes available.	I	C
Flexible institutional triggers and plans for scaling cardiac service line activity up or down in response to government regulations, hospital capacity, and disease burden should be agreed and widely communicated with clinicians to minimize the adverse impact on patients of abrupt changes in clinical practice.	I	C
Reduced cardiac critical care capacity mandates safe and effective triage of elective cardiac surgery patients: such triage should be led by specialists in cardiac surgery, using formal guidelines agreed by the heart team.	I	C
Clear, accurate, and timely information and guidance should be provided to referring physicians, patients, and the community on the availability of cardiovascular services and how to access them.	I	C
A regional response may be a reasonable strategy to ensure appropriate delivery of elective cardiac surgery.	IIa	C
It is reasonable to substitute a less invasive approach if insufficient hospital capacity precludes planned cardiac surgery and patient preference, informed by a shared decision-making approach with the heart team, supports the balance of risk and benefit.	IIa	C
Cardiac surgery care provision
All cardiac surgery patients should be screened preoperatively for COVID-19 and consideration given to deferring care or other care modalities for patients that test positive.	I	C
Cardiac surgery intensive care should be structured so that cardiac surgical patients with SARS-CoV-2 may be cohorted within the unit and infection risk to other patients and health care workers is minimized.	I	C
Surgical procedures on patients with SARS-CoV-2 should be minimized and performed with strict adherence to protocols designed to mitigate risk posed to health care workers.	I	C
Discharging postoperative cardiac surgery patients to nursing facilities where increased prevalence of SARS-CoV-2 infection and mortality has been observed is not beneficial and may cause harm.	III (no benefit)	C
Cardiac surgery research and education: Recommendations
Remote working and telemedicine may be used to provide close and convenient patient follow-up and minimize the exposure of patients and health care workers to infection.	IIa	C
It is reasonable to revise resident rotations to address reduced operative experience and support research programs halted or suspended during the pandemic response.	IIa	C

SARs-CoV-2, severe acute respiratory syndrome coronavirus 2.