COVID-19: Crisis Management in Congenital Heart Surgery

Our nation’s health care infrastructure faces unprecedented challenges in the face of the COVID19 pandemic, and the congenital heart disease (CHD) community is no exception. These challenges include looming resource scarcities of equipment, personnel, and blood. In addition, there are the substantial infection risks to patients, family members and staff. These factors necessitate thoughtful but often difficult decisions on how to best triage patients with CHD. Our relatively small workforce adds another dimension to the challenge, since the rapid spread of COVID-19 could result in program closure at a moment’s notice secondary to insufficient personnel from infection or quarantine. While many sectors of our society can be placed on hiatus during this period of crisis, our patients’ diseases continue requiring care, particularly amongst newborns and infants who often require surgery during a narrow temporal window for satisfactory outcomes. Practitioners are tasked with optimizing care in the presence of the current and rapidly changing circumstances. While statements have been published relative to adults undergoing surgery, guidance with respect to congenital heart disease patients is currently lacking and is the goal of this manuscript. As we have seen in other countries facing this pandemic, the thoughtful allocation of resources is paramount to the overall welfare of the community and has led to such strategies in our country. The safety of our patients, healthcare providers, and our communities is our chief concern. This document is not meant to be a guideline but is designed to provide guidance for decision-making as we face unparalleled challenges related to congenital cardiac surgery care during this pandemic.