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1.
Semin Cardiothorac Vasc Anesth ; 26(2): 129-139, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1865252

ABSTRACT

This review focuses on the literature published during the calendar year 2021 that is of interest to anesthesiologists taking care of children and adults with congenital heart disease. Four major themes are discussed, including cardiovascular disease in children with COVID-19, aortic valve repair and replacement, bleeding and coagulation, and enhanced recovery after surgery (ERAS).


Subject(s)
Anesthesia , Anesthesiology , COVID-19 , Cardiac Surgical Procedures , Heart Defects, Congenital , Adult , Child , Heart Defects, Congenital/surgery , Humans
2.
Methodist Debakey Cardiovasc J ; 18(2): 106-107, 2022.
Article in English | MEDLINE | ID: covidwho-1766194

ABSTRACT

A 52-year-old female was admitted to our hospital in April 2021 with dyspnea. She was discharged from the hospital 3 weeks ago due to the diagnosis of pneumonia caused by coronavirus disease 2019 (COVID-19). Physical examination revealed an oxygen desaturation of 82%. The patient underwent computed tomography angiography (CTA) that showed a ground-glass pattern and a giant left atrial appendage ( Figure 1A ). Film array respiratory panel was negative, and pulmonary aspergillosis was diagnosed after bronchoscopy. Cardiac magnetic resonance corroborated the huge left atrial appendage ( Figure 1B ). No other structural or functional heart abnormalities were diagnosed. A giant left atrial appendage is a rare cardiac anomaly that can be congenital or acquired. In the literature, it is called a left atrial appendage aneurysm. The dilatation can be generalized or focused. Although it can occur in all age groups, it is predominant in patients in their 30s to 50s and most common in females.1 Patients can be asymptomatic or present with symptoms such as palpitations, chest pain, or dyspnea. A number of recent cases in the literature have highlighted the diagnostic utility of CTA.2 While there is no standard treatment for this condition, surgical resection is the most frequent therapy. Another option reported in the literature is anticoagulant treatment for select cases.3 Closure of the left atrial appendage is a more recent and emerging intervention that can be considered. In our patient, we initiated anticoagulant therapy to reduce the risk of thromboembolic events; however, we recommended left atrial appendage occlusion or surgical resection after completing the treatment for pulmonary aspergillosis.


Subject(s)
Atrial Appendage , COVID-19 , Heart Aneurysm , Heart Defects, Congenital , Pulmonary Aspergillosis , Anticoagulants , Atrial Appendage/diagnostic imaging , Dyspnea/etiology , Female , Heart Aneurysm/surgery , Heart Defects, Congenital/complications , Heart Defects, Congenital/diagnostic imaging , Heart Defects, Congenital/surgery , Humans , Middle Aged , Pulmonary Aspergillosis/pathology
4.
Cardiol Young ; 32(1): 31-35, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1635444

ABSTRACT

INTRODUCTION: The Coronavirus Disease 2019 (COVID-19) pandemic negatively impacted global healthcare. Consequences in Pediatric and Congenital Heart Surgery programmes and mortality of congenital heart patients infected with severe acute respiratory syndrome coronavirus-2 (SARS-Cov-2) is still to be determined. OBJECTIVE: To study the COVID-19 pandemic implications in Brazilian Pediatric and Congenital Heart Surgery programmes. METHODS: We conducted a national online survey covering all states that perform Pediatric and Congenital Heart Surgery from 10 November to 22 November, 2020, using a Google forms questionnaire. We formulated questions related to impact on surgical volume, case-mix, and mortality. Then we asked about short-term post-operative COVID-19 infection and outcomes. RESULTS: We received responses from 46 centres representing all states where there were a Pediatric and Congenital Heart Surgery programme and all high-volume centres across the country. All but one centre experienced a significant decrease in surgical volume, and 23.9% of the responders revealed less than one-quarter of volume decrement. On the other hand, in over 70% of the centres, there was a significant surgical volume reduction. In addition to this, there was a shift in case-mix in 41 centres (89.1%) towards more complex cases. More than one-third of the responders revealed increased mortality in 2020 compared to previous years, and 43.5% of the programmes (20 centres) had at least one patient contaminated by SARS-Cov-2, accounting for 48 patients. Mortality in post-operative infected patients was 45.8% (22 patients). CONCLUSIONS: In general, Brazilian Pediatric and Congenital Heart Surgery programmes were severely affected by decreased surgical volume, unbalanced case-mix towards more complex cases, and increased mortality. Almost half of the programmes related post-operative COVID-19 contamination with high mortality.


Subject(s)
COVID-19 , Heart Defects, Congenital , Brazil/epidemiology , Child , Heart Defects, Congenital/epidemiology , Heart Defects, Congenital/surgery , Humans , Pandemics , SARS-CoV-2
5.
BMC Cardiovasc Disord ; 21(1): 592, 2021 12 09.
Article in English | MEDLINE | ID: covidwho-1566507

ABSTRACT

BACKGROUND: COVID-19 and Fontan physiology have each been associated with an elevated risk of venous thromboembolism (VTE), however little is known about the risks and potential consequences of having both. CASE PRESENTATION: A 51 year old male with tricuspid atresia status post Fontan and extracardiac Glenn shunt, atrial flutter, and sinus sick syndrome presented with phlegmasia cerulea dolens (PCD) of the left lower extremity in spite of supratherapeutic INR in the context of symptomatic COVID-10 pneumonia. He was treated with single session, catheter directed mechanical thrombectomy that was well-tolerated. CONCLUSIONS: This report of acute PCD despite therapeutic anticoagulation with a Vitamin K antagonist, managed with emergent mechanical thrombectomy, calls to attention the importance of altered flow dynamics in COVID positive patients with Fontan circulation that may compound these independent risk factors for developing deep venous thrombosis with the potential for even higher morbidity.


Subject(s)
COVID-19 , Fontan Procedure , Gangrene , Mechanical Thrombolysis , Postoperative Complications , Thrombophlebitis , Tricuspid Atresia , Warfarin/therapeutic use , Amputation/methods , Atrial Flutter/drug therapy , Atrial Flutter/etiology , COVID-19/blood , COVID-19/complications , COVID-19/therapy , Fontan Procedure/adverse effects , Fontan Procedure/methods , Gangrene/etiology , Gangrene/surgery , Heart Defects, Congenital/surgery , Humans , Image Processing, Computer-Assisted/methods , Lower Extremity/blood supply , Lower Extremity/pathology , Lower Extremity/surgery , Male , Mechanical Thrombolysis/adverse effects , Mechanical Thrombolysis/methods , Middle Aged , Phlebography/methods , Postoperative Complications/diagnosis , Postoperative Complications/physiopathology , Postoperative Complications/surgery , Sick Sinus Syndrome/diagnosis , Sick Sinus Syndrome/etiology , Thrombophlebitis/diagnosis , Thrombophlebitis/etiology , Thrombophlebitis/surgery , Tomography, X-Ray Computed/methods , Treatment Outcome , Tricuspid Atresia/etiology , Tricuspid Atresia/surgery
6.
G Ital Cardiol (Rome) ; 22(11): 871-883, 2021 Nov.
Article in Italian | MEDLINE | ID: covidwho-1496709

ABSTRACT

Pediatric cardiology has matured profoundly over the last 50 years, paralleled by a similar development in pediatric cardiac surgery and cardiac anesthesia. This field of medicine provides structured and effective care for a very heterogeneous group of diseases including congenital heart disease, cardiomyopathies and heart failure, myocarditis, rheumatic heart disease, inherited and acquired arrhythmias, Kawasaki disease and more recently multisystemic inflammatory syndrome of children related to primary infection by SARS-CoV-2. This review summarizes achievements and results in selected topics of pediatric cardiology and cardiac surgery with focused attention to the diagnosis and management of congenital heart diseases.


Subject(s)
COVID-19 , Cardiology , Fontan Procedure , Heart Defects, Congenital , Child , Fontan Procedure/adverse effects , Heart Defects, Congenital/surgery , Humans , SARS-CoV-2
7.
Appl Clin Inform ; 12(4): 768-773, 2021 08.
Article in English | MEDLINE | ID: covidwho-1361660

ABSTRACT

OBJECTIVES: This study aimed to explore the effect of applying WeChat in the follow-up and health education of children after congenital heart disease (CHD) surgery during the coronavirus disease 2019 (COVID-19) epidemic. METHODS: Data from 135 children were retrospectively analyzed. The care burden, anxiety, depression, and satisfaction of the parents of patients at home were analyzed and compared. RESULTS: One month after discharge, the Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), Zarit Burden Interview (ZBI), and Patient Satisfaction Questionnaire-18 scores of the WeChat follow-up group were significantly better than those of the outpatient follow-up group (p < 0.05). Compared with the discharge time, the SAS, SDS, and ZBI scores were significantly improved in the WeChat follow-up group but not in the outpatient follow-up group (p < 0.05). CONCLUSION: During the COVID-19 epidemic, the application of WeChat to the follow-up management of children after CHD surgery can effectively reduce care burden and relieve anxiety and depression in parents at home. It can also improve the satisfaction of parents with medical treatment.


Subject(s)
COVID-19 , Heart Defects, Congenital , Anxiety/epidemiology , Child , Depression/epidemiology , Heart Defects, Congenital/surgery , Humans , Pandemics , Parents , Retrospective Studies , SARS-CoV-2 , Surveys and Questionnaires
8.
J Cardiovasc Med (Hagerstown) ; 22(9): 701-705, 2021 09 01.
Article in English | MEDLINE | ID: covidwho-1339452

ABSTRACT

The Coronavirus disease 2019 (COVID-19) pandemic has thoroughly and deeply affected the provision of healthcare services worldwide. In order to limit the in-hospital infections and to redistribute the healthcare professionals, cardiac percutaneous intervention in Pediatric and Adult Congenital Heart Disease (ACHD) patients were limited to urgent or emergency ones. The aim of this article is to describe the impact of the COVID-19 pandemic on Pediatric and ACHD cath laboratory activity during the so-called 'hard lockdown' in Italy. Eleven out of 12 Italian institutions with a dedicated Invasive Cardiology Unit in Congenital Heart Disease actively participated in the survey. The interventional cardiology activity was reduced by more than 50% in 6 out of 11 centers. Adolescent and ACHD patients suffered the highest rate of reduction. There was an evident discrepancy in the management of the hard lockdown, irrespective of the number of COVID-19 positive cases registered, with a higher reduction in Southern Italy compared with the most affected regions (Lombardy, Piedmont, Veneto and Emilia Romagna). Although the pandemic was brilliantly addressed in most cases, we recognize the necessity for planning new, and hopefully homogeneous, strategies in order to be prepared for an upcoming new outbreak.


Subject(s)
COVID-19 , Cardiac Surgical Procedures , Emergency Medical Services , Heart Defects, Congenital , Infection Control , Risk Management/methods , Adolescent , Adult , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/transmission , Cardiac Surgical Procedures/methods , Cardiac Surgical Procedures/statistics & numerical data , Civil Defense/methods , Civil Defense/trends , Disease Transmission, Infectious/prevention & control , Emergency Medical Services/methods , Emergency Medical Services/statistics & numerical data , Female , Heart Defects, Congenital/epidemiology , Heart Defects, Congenital/surgery , Humans , Infection Control/methods , Infection Control/organization & administration , Italy/epidemiology , Male , Organizational Innovation , SARS-CoV-2
9.
Pediatr Cardiol ; 42(7): 1483-1487, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1318750

ABSTRACT

In this review, we provide a brief description of recently published articles addressing topics relevant to pediatric cardiologists. Our hope is to provide a summary of the latest articles published recently in other journals in our field. The articles address (1) outcomes for COVID-19 infection in adults with congenital heart disease which showed no increased mortality compared to the general population, (2) hepatorenal dysfunction before transplantation in patients with Fontan is associated with increased mortality, (3) abnormal Von Willebrand factor metabolism and angiopoietin signaling may contribute to pulmonary AVM formation in children with a Glenn circulation, (4) low cardiac output after the Norwood procedure which improves with higher hemoglobin and with milrionone, (5) a comparison of staged versus complete repair in neonatal tetralogy of Fallot reveiling the pros and cons of each strategy, (6) the long-term outcomes of early repair of complete atrioventricular canal show no difference in outcomes in patients who were repaired below 3 months of life.


Subject(s)
COVID-19 , Heart Defects, Congenital , Heart Septal Defects , Periodicals as Topic , Tetralogy of Fallot , Adult , Child , Heart Defects, Congenital/surgery , Humans , Infant, Newborn , SARS-CoV-2 , Treatment Outcome
10.
World J Pediatr Congenit Heart Surg ; 12(4): 500-507, 2021 07.
Article in English | MEDLINE | ID: covidwho-1317117

ABSTRACT

INTRODUCTION: The purpose was to explore the experience, information and support needs, and decision-making of parents of children with congenital heart disease (CHD), as well as the children/young people themselves, during the COVID-19 crisis. MATERIALS AND METHODS: A survey study of parents of children with CHD, children and young people, capturing experiences, decision-making, information, and support needs during the COVID-19 crisis was conducted. The survey launched for one month (April 9, 2020) during the first infection wave in the United Kingdom and subsequent restriction of free movement under lockdown rules from March 23, 2020, until May 31, 2020. RESULTS: One hundred eighty-four parents and 36 children/young people completed the survey. Parents were more likely to worry about the virus (86.4%) than children/young people (69.4%), while (89%) parents were more vigilant for symptoms of the virus versus children/young people (69.4%). A thematic analysis of the qualitative comments covered 34 subthemes, forming eight overarching themes: Virus-(1) risk of infection; (2)information, guidance, and advice; (3) change in health care provision; and (4) fears and anxieties, and lockdown and isolation-(5) psychological and social impact, (6) keeping safe under lockdown, (7) provisions and dependence on others, and (8) employment and income. CONCLUSIONS: There was widespread concern over the virus especially among parents. Parents and children/young people, however, were frustrated with the lack of specific and pediatric-focused information and guidance, expressing disappointment with the adult-centric information available. Parents also felt alone, especially with their concerns around the implications of cardiac service suspension and the implication for their child's health. In order to better support children and their families, resources need to be developed to address families' and children/young people's concerns for their health during this pandemic.


Subject(s)
COVID-19 , Heart Defects, Congenital , Adolescent , Adult , Child , Communicable Disease Control , Heart Defects, Congenital/surgery , Humans , Parents , SARS-CoV-2
11.
Cardiol Young ; 32(1): 150-153, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1265909

ABSTRACT

Coronavirus disease 2019 causes respiratory and systemic disease and has led to a sudden epidemic affecting people of all ages. Patients with congenital heart disease represent a high-risk population. In this article, we present a newborn who required extracorporeal membrane oxygenation support for acute respiratory failure in the early postoperative period due to exposure to severe acute respiratory syndrome coronavirus 2 after aortic arch repair and ventricular septal defect closure. To the best of our knowledge, this patient represents the first neonatal case of severe acute respiratory syndrome coronavirus 2 infection after congenital heart surgery and is the youngest patient to need extracorporeal membrane oxygenation support.


Subject(s)
COVID-19 , Extracorporeal Membrane Oxygenation , Heart Defects, Congenital , Respiratory Distress Syndrome , Heart Defects, Congenital/surgery , Humans , Infant, Newborn , SARS-CoV-2
12.
Semin Cardiothorac Vasc Anesth ; 25(2): 107-119, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1231220

ABSTRACT

This review focuses on the literature published during the calendar year 2020 that is of interest to anesthesiologists taking care of children and adults with congenital heart disease. Five major themes are discussed, including COVID-19 in children with heart disease, race and outcome disparities in congenital heart disease, Norwood procedure and outcomes, Fontan procedure and outcomes, and neurotoxicity/neurologic outcomes. A total of 59 peer-reviewed articles are discussed.


Subject(s)
Anesthesia/methods , COVID-19/complications , Heart Defects, Congenital/surgery , Adult , COVID-19/physiopathology , Child , Fontan Procedure , Health Status Disparities , Heart Defects, Congenital/epidemiology , Humans , Norwood Procedures
13.
Ann Thorac Surg ; 113(2): e119-e121, 2022 02.
Article in English | MEDLINE | ID: covidwho-1219341

ABSTRACT

This case highlights the need for accurate and rapid testing for severe acute respiratory syndrome coronavirus 2 and also underscores the need for caregivers to remain vigilant for coronavirus disease 2019 in the postoperative setting despite negative preoperative testing.


Subject(s)
COVID-19/therapy , Heart Defects, Congenital/surgery , Postoperative Complications/therapy , SARS-CoV-2 , Extracorporeal Membrane Oxygenation , Humans , Infant , Male
14.
Int J Qual Health Care ; 33(2)2021 Apr 22.
Article in English | MEDLINE | ID: covidwho-1174913

ABSTRACT

OBJECTIVE: During the COVID-19 pandemic, parents of infants having medical problem face challenges of insufficient medical resources at home. The purpose of this study was to investigate the effect of WeChat-based telehealth services on the preoperative follow-up of infants with congenital heart disease (CHD) during the COVID-19 pandemic. METHODS: This study retrospectively analyzed the medical records of 190 infants with CHD who underwent remote follow-up via WeChat from December 2019 to May 2020 in Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University. In addition, the psychological benefits of WeChat on the parents of these infants were analyzed. RESULTS: In total, 190 infants were involved in this study, including 72 cases of ventricular septal defects, 42 cases of patent ductus arteriosus, 55 cases of atrial septal defects, 3 cases of tetralogy of Fallot, 2 cases of endocardial cushion defects, 12 cases of pulmonary stenosis, 2 cases of total anomalous pulmonary venous connection and 2 cases of aortic arch constriction. During the follow-up period, 48 infants who received surgical indications were hospitalized in time for surgical treatment. It was recommended that 10 infants with respiratory tract infections be treated in local hospitals through the WeChat platform. We provided feeding guidance to 28 infants with dysplasia through the WeChat platform. The psychological evaluation results of parents showed that the median score and range of Self-Rating Depression Scale scores were 42 and 32-58, respectively. Nine parents (4.7%) were clinically depressed, while the majority had mild depression. The median score and range of Self-Rating Anxiety Scale scores were 44 and 31-59, respectively. Twenty parents (10.5%) had clinical anxiety, while the rest had mild anxiety. CONCLUSION: During the COVID-19 pandemic, follow-up management and health services for infants with CHD prior to surgery through the WeChat platform were useful in identifying the state of an infant's condition as well as in identifying and relieving care pressure, anxiety and depression in the parents.


Subject(s)
Heart Defects, Congenital/surgery , Parents/education , Parents/psychology , Telemedicine/methods , Adult , COVID-19/prevention & control , China/epidemiology , Female , Humans , Infant , Infant, Newborn , Male , Remote Consultation , Retrospective Studies , SARS-CoV-2 , Social Media
15.
J Cardiothorac Vasc Anesth ; 35(10): 2848-2854, 2021 10.
Article in English | MEDLINE | ID: covidwho-1164969

ABSTRACT

This article is a review of the highlights of pertinent literature published during the 12 months of 2020 that are of interest to the congenital cardiac anesthesiologist. After a search of the US National Library of Medicine's PubMed database, several topics emerged for which significant contributions were made in 2020. The authors of the present article considered the following topics noteworthy to be included in this review: pediatric cardiac care in the coronavirus disease 2019 era, the use of mechanical circulatory support in coronavirus disease 2019-related multisystem inflammatory syndrome in children, transfusion and coagulation management in children undergoing congenital heart surgery, and pulmonary vein stenosis.


Subject(s)
Anesthesia, Cardiac Procedures , COVID-19 , Heart Defects, Congenital , Child , Heart Defects, Congenital/surgery , Humans , SARS-CoV-2 , Systemic Inflammatory Response Syndrome
16.
Cardiol Young ; 30(9): 1288-1296, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-1084349

ABSTRACT

INTRODUCTION: In this report, we aim to present our algorithm and results of patients with congenital cardiac disorders who underwent surgical or interventional procedures during the peak phase of the pandemics in our country. PATIENTS AND METHODS: The first COVID-19 case was diagnosed in Turkey on 11 March, 2020, and the peak phase seemed to end by the end of April. All the patients whom were referred, treated, or previously operated but still at the hospital during the peak phase of COVID-19 pandemics in the country were included into this retrospective study. Patient's diagnosis, interventions, adverse events, and early post-procedural courses were studied. RESULTS: Thirty-one patients with various diagnoses of congenital cardiovascular disorders were retrospectively reviewed. Ages of the patients ranged between 2 days and 16 years. Seventeen cases were males and 14 cases were females. Elective cases were postponed. Priority was given to interventional procedures, and five cases were treated percutaneously. Palliative procedures were preferred in patients whom presumably would require long hospital stay. Corrective procedures were not hesitated in prioritised stable patients. Mortality occurred in one patient. Eight patients out of 151 ICU admissions were diagnosed with COVID-19, and they were transferred to COVID-19 ICU immediately. Three nurses whom also took care of the paediatric cases became infected with SARS-CoV-2; however, the children did not catch the disease. CONCLUSION: Mandatory and emergent congenital cardiac percutaneous and surgical procedures may be performed with similar postoperative risks as there are no pandemics with meticulous care and preventive measures.


Subject(s)
Cardiovascular Surgical Procedures , Coronavirus Infections , Heart Defects, Congenital , Infection Control/organization & administration , Pandemics , Pneumonia, Viral , Postoperative Complications , Adolescent , COVID-19 , Cardiovascular Surgical Procedures/adverse effects , Cardiovascular Surgical Procedures/methods , Cardiovascular Surgical Procedures/statistics & numerical data , Child, Preschool , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Female , Heart Defects, Congenital/diagnosis , Heart Defects, Congenital/epidemiology , Heart Defects, Congenital/surgery , Humans , Infant, Newborn , Male , Outcome and Process Assessment, Health Care , Pandemics/prevention & control , Patient Selection , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Turkey/epidemiology
18.
Paediatr Anaesth ; 31(2): 213-220, 2021 02.
Article in English | MEDLINE | ID: covidwho-1066748

ABSTRACT

BACKGROUND: The COVID-19 pandemic has compounded many existing healthcare delivery challenges including long waiting lists and cost containment. New challenges have arisen, such as demand on supply of personal protective equipment (PPE) and the implications of social distancing on staff, patients, and their families. Despite the pandemic, the need to deliver safe, urgent congenital cardiac surgery has remained. OBJECTIVE: To demonstrate how Lean methodology can improve PPE supply chain demand and reduce staff exposure to children with unknown SARS-CoV-2 status undergoing congenital cardiac surgery, during the COVID-19 pandemic. METHODS: We implemented the define, measure, analyze, improve, and control method (DMAIC) and Value Stream Maps to eliminate waste steps during testing for SARS-CoV-2 for children undergoing congenital cardiac surgery. RESULTS: Following a 3-week period of implementation of this new value stream map, we reduced PPE set usage from 13 to 1 per patient, resulting in an annual saving of over €36,000 and reducing single-use plastic waste by nearly 70 000 pieces per annum. We reduced numbers of staff exposed to patients with an unknown SARS-CoV-2 status from 13 to 1. CONCLUSION: The use of Lean methodology can reduce waste of PPE and plastic, resulting in cost savings, while reducing staff exposure when testing patients with congenital cardiac disease for SARS-CoV-2. By preventing admission of SARS-CoV-2-positive patients, we can reduce use of isolation beds and prevent cancellation of surgery, improving patient flow and departmental efficiency. Other departments in our institution are implementing similar admission pathways to allow surgical services to restart during the ongoing pandemic.


Subject(s)
COVID-19/epidemiology , Cardiac Surgical Procedures/standards , Heart Defects, Congenital/surgery , Infection Control/methods , Personal Protective Equipment/supply & distribution , Adolescent , COVID-19/prevention & control , COVID-19/transmission , Cardiac Surgical Procedures/instrumentation , Child , Child, Preschool , Humans , Infant , Infant, Newborn , SARS-CoV-2/isolation & purification
20.
Eur J Cardiothorac Surg ; 58(6): 1254-1260, 2020 12 01.
Article in English | MEDLINE | ID: covidwho-1060127

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.


Subject(s)
COVID-19/prevention & control , Cardiac Surgical Procedures/trends , Health Care Rationing/trends , Health Services Accessibility/trends , Heart Defects, Congenital/surgery , COVID-19/epidemiology , Cross Infection/epidemiology , Cross Infection/prevention & control , Elective Surgical Procedures/trends , Emergencies , Health Care Rationing/methods , Health Care Rationing/organization & administration , Health Care Surveys , Health Policy , Health Services Accessibility/organization & administration , Humans , Infection Control/methods , Italy/epidemiology , Occupational Diseases/epidemiology , Occupational Diseases/prevention & control , Pandemics , Postoperative Complications/epidemiology , Postoperative Complications/prevention & control , Quarantine
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