Clinical Outcomes of Delayed Pediatric Cardiac Surgery and Catheterizations During the COVID-19 Pandemic: Lessons Learned From a Capacity Crisis.

OBJECTIVES: To evaluate the periprocedural outcomes of congenital heart disease procedures that were delayed during the COVID-19 pandemic compared to prepandemic controls. DESIGN: Retrospective matched cohort study (1:2) based on age, cardiac diagnosis, and procedure type. SETTING: Tertiary pediatric heart center, March 11 to June 8, 2020. PARTICIPANTS: Patients whose cardiac procedures were delayed during the pandemic were matched with prepandemic controls. Delayed surgical patients (n = 87, median age 7 years) and catheterization patients (n = 126, median age 10 years) were well matched clinically and demographically, although delayed cases had more genetic syndromes, arrhythmias, and comorbidities. INTERVENTIONS: Multidisciplinary triage individually selected patients for procedural delay. MEASUREMENT AND MAIN RESULTS: Periprocedural outcomes, use of vasoactive agents, ventilation time, procedure time, residual lesions, length of stay, and adverse events were compared between groups. Delayed surgical cases experienced slightly longer cross-clamp time (142 v 130 minutes, p = 0.017), shorter postoperative ventilation time (6.9 v 14.1 hours, p = 0.001), and shorter postoperative stay (5.1 v 6.5 days, p = 0.001). Delayed catheterization patients had fewer preprocedural admissions (4% v 17.5%, p = 0.001), slightly higher inotropic scores, and fewer intensive care unit admissions (5.6% v 12.3%, p = 0.046). There was 1 known preoperative death in a surgical patient pending transfer; otherwise, mortality and adverse event rates were similar between groups. CONCLUSIONS: Careful triage protocols and pandemic-related changes in workflow allowed for safe postponement of congenital cardiac procedures despite higher medical complexity in delayed patients. These findings underscore the effectiveness of individualized triage and suggest opportunities to refine care delivery beyond crisis contexts.