Objective 

By 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.

Methods 

We 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.

Results 

From 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.

Conclusion 

Our 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.

中文翻译：

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Covid-19大流行之后，先天性心脏病患者的伦巴第大区紧急改组。

目的 

到2020年2月底，COVID-19大流行性感染已在意大利北部传播，数千名患者被感染。在受灾最严重的伦巴第地区，大多数公立和私立医院都致力于照顾COVID-19患者，并按照“ Hub-and-Spoke”模式针对其他医学专业（例如心脏外科手术和先天性介入手术）进行组织心脏病（CHD）。在这里，我们报告伦巴第地区如何修改先天性心脏保健系统，以及该组织的最初成果。

方法 

我们描述了一种经过修改的“辐射型”模型-涉及59个出生地和三个专门的先天性心脏病中心-以及中心中心如何组织其活动。我们还报告了在此期间住院的连续病例的数据。

结果 

从3月9日至4月15日，我们进行了：总共21例心脏外科手术，4例诊断性导管插入术，3例CT扫描和2例CMR。在三例产前诊断中，已安排了分娩。代言中心提到了我们中心的六个先天性心脏病病例。在两种情况下需要术后肠外膜氧合支持。一例死亡。这些患者或其父母或陪伴者均未发现COVID-19阳性；发现2名儿科强化医师为COVID-19阳性，需要住院而无机械通气；13名护士的COVID拭子阳性（4例有症状），并在家中进行了管理和隔离。

结论 

我们的初步数据表明，采用该模型的患者可以立即获得良好的结果，而不会增加死亡率，也不会暴露COVID-19。