Impact of the coronavirus disease 2019 (COVID-19) pandemic on the Italian congenital cardiac surgery system: a national survey

Abstract

Objectives: Italy has been one of the countries most severely affected by the coronavirus disease 2019 (COVID-19). The Italian government was forced to introduce quarantine measures quickly, and all elective health services were stopped or postponed. This emergency has dramatically changed the management of paediatric and adult patients with congenital heart disease. We analysed data from 14 Italian congenital cardiac surgery centres during lockdown, focusing on the impact of the pandemic on surgical activity, patients and healthcare providers and resource allocation.

Methods: Fourteen centres participated in this study. The period analysed was from 9 March to 4 May. We collected data on the involvement of the hospitals in the treatment of patients with COVID-19 and on limitations on regular activity and on the contagion among patients and healthcare providers.

Results: Four hospitals (29%) remained COVID-19 free, whereas 10 had a 39% reduction in the number of beds for surgical patients, especially in the northern area. Two hundred sixty-three surgical procedures were performed: 20% elective, 62% urgent, 10% emergency and 3% life-saving. Hospital mortality was 0.4%. Compared to 2019, the reduction in surgical activity was 52%. No patients operated on had positive test results before surgery for severe acute respiratory syndrome coronavirus 2, the virus responsible for COVID-19. Three patients were infected during the postoperative period. Twenty-nine nurses and 12 doctors were infected. Overall, 80% of our infected healthcare providers were in northern centres.

Conclusions: Our study shows that the pandemic had a different impact on the various Italian congenital cardiac surgery centres based on the different patterns of spread of the virus across the country. During the lockdown, the system was able to satisfy all emergency clinical needs with excellent results.

Keywords: Cardiac surgery; Congenital heart disease; Coronavirus disease 2019; Pandemic.

Figure 1:

Congenital cardiac surgery units in Italy. Blue: centres in the northern area; orange: centres in the central area; green: centres in the southern area.

Figure 2:

Hospital reconfiguration after coronavirus disease 2019 emergency.

Figure 3:

Number and type (priority) of surgical procedures performed during the lockdown.

Figure 4:

Surgical procedures performed during the lockdown. ASD: atrial septal defect; ASO: arterial switch operation; AVSD: atrioventricular septal defect; BT: Blalock–Taussig; COA: coarctation; ECMO: extracorporeal membrane oxygenation; GUCH: grown-up congenital heart disease; HT: heart transplant; IAAO: interrupted aortic arch; LVOTR: left ventricular outflow tract repair; PA + VSD: pulmonary atresia and ventricular septal defect; PAB: pulmonary artery banding; PDA: patent ductus arteriosus; proc.: procedure; PVR: pulmonary valve replacement; RVOTR: right ventricular outflow tract repair; SVAS + PS: supravalvular aortic stenosis and pulmonary stenosis; SVPS: supravalvular pulmonary stenosis; triatriat: triatriatum; TAPVD: total anomalous pulmonary vein drainage; TOF: tetralogy of Fallot; VAD: ventricular assist device; VSD: ventricular septal defect.