• Massimo Chessa, Alessandro Varrica, Andreea Andronache, Mario Carminati, Anna Maria Colli, Angelo Fabio D'Aiello, Paolo Ferrero, Savina Mannarino, Simona Marcora, Stefano Maria Marianeschi, Angelo Micheletti, Luciane Piazza, Antonio Saracino, Nicola Uricchio, Gabriele Vignati, and Alessandro Giamberti.
• ACHD Unit.
• J Cardiovasc Med (Hagerstown). 2020 Sep 1; 21 (9): 654-659.

ObjectiveBy the end of February 2020, the COVID-19 pandemic infection had spread in Northern Italy, with thousands of patients infected. In Lombardy, the most affected area, the majority of public and private hospitals were dedicated to caring for COVID-19 patients and were organized following the 'Hub-and-Spoke' model for other medical specialties, like cardiac surgery and interventional procedures for congenital cardiac disease (CHD). Here, we report how the congenital cardiac care system was modified in Lombardy and the first results of this organization.MethodsWe describe a modified 'Hub-and-Spoke' model - that involves 59 birthplaces and three specialized Congenital Cardiac Centers -- and how the hub center organized his activity. We also reported the data of the consecutive cases hospitalized during this period.ResultsFrom 9 March to 15 April, we performed: a total of 21 cardiac surgeries, 4 diagnostic catheterizations, 3 CT scans, and 2 CMR. In three cases with prenatal diagnosis, the birth was scheduled. The spoke centers referred to our center six congenital cardiac cases. The postop ExtraCorporeal Membrane Oxygenation support was required in two cases; one case died. None of these patients nor their parents or accompanying person was found to be COVID-19-positive; 2 pediatric intensivists were found to be COVID-19-positive, and needed hospitalization without mechanical ventilation; 13 nurses had positive COVID swabs (4 with symptoms), and were managed and isolated at home.ConclusionOur preliminary data suggest that the model adopted met the immediate needs with a good outcome without increased mortality, nor COVID-19 exposure for the patients who underwent procedures.

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