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. 2020 Jul 2;160(4):937–947.e2. doi: 10.1016/j.jtcvs.2020.04.060

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© 2020 Jointly between The American Association for Thoracic Surgery, The Society of Thoracic Surgeons, and the European Association for Cardio-Thoracic Surgery. Published by Elsevier Inc.

Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

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A, Decision-making strategy for surgical planning based on pandemic phase, given operative risks and expected life years gained, resource use, and resource limitations. In this figure, 3 phases of pandemic can be plotted with resource expenditure on the vertical axis (blue line: resources available; orange line: resource use), and operative risk and expected survival benefit on the horizontal axis. The intersection of the orange and blue resource lines represents the maximum case threshold for a health care system at a given time. This graph thus incorporates the changing level of resources at different stages of the pandemic, as illustrated by a sample case of an 80-year-old patient with CKD requiring AVR/CABG. In B, during the peak of the pandemic, this operation is not justified; in C, during later stages of the pandemic, this operation is justified. CKD, Chronic kidney disease; AVR, aortic valve replacement; CABG, coronary artery bypass grafting.