Cardiac Surgery During the Coronavirus Disease 2019 Pandemic: Perioperative Considerations and Triage Recommendations

Figure 1. Perioperative severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) testing strategy for patients without acute infection undergoing cardiac surgery. *This testing algorithm provides guidance on personal protective equipment (PPE). The decision to perform a case is primarily dependent on the surgical indication (tier 1, 2 or 3 [Table 2]) and not coronavirus disease 2019 (COVID‐19) testing. However, knowing the COVID‐19 test results may help with guidance for surgical timing, patient counseling on postoperative complications, and allocation of hospital resources. †If resources to test all preoperative patients are available, we recommend universal testing for the reasons mentioned above. The test should be performed as close to surgery as possible. Time permitting, tier 3 patients may also be tested. ‡Stratification by pretest probability is useful in limited‐resource settings. Local/regional disease prevalence may serve as a surrogate for the pretest probability. High pretest probability: local community/facility prevalence of >20% to 50%; intermediate pretest probability: for patients who are not considered to have high pretest probability or low pretest probability; low…

Figure 2. The relationship of positive and negative predictive value to prevalence. This schematic illustrates the relationship between positive predictive value (PPV), upper left, and negative predictive value (NPV), lower left, to prevalence. Varying sensitivities for these assays are also illustrated (red, 90%; blue, 80%; green, 70%; purple, 60%; all groups use specificity of 95%). In a low‐prevalence setting, the PPV is low. In high‐prevalence settings, the NPV falls below 80% to 90%. In intermediate‐prevalence settings, the PPV and NPV are both high. The diagnostic test may, therefore, be the most valuable for patients with intermediate pretest probability. Each facility should review its local thresholds for PPV and NPV, and review its facility's diagnostic assay. The schematic was created by A.C.3