Perspective on Pediatric/Congenital Cardiac Catheterization in Response to the First Wave of COVID

Corresponding Author

this period to be particularly challenging with limitations in hospital-based resources and supply chain limitations.While there was no standard approach to this first wave of COVID, many congenital cardiac catheterization laboratories responded by performing only medically urgent cases, thereby increasing case complexity and decreasing overall volume.This approach primarily led to pre-reviewed, higher-risk procedures being performed by a core group of catheterization laboratory staff and physicians.While many have appreciated the increased stress systembased issues created through the demand of performing only high-risk procedures, the outcomes of these procedures had previously not been analyzed.This article uniquely compares procedural outcomes during the pre-COVID, first wave of COVID, and postfirst-wave periods.Findings of stable to even improved overall outcomes despite the case-mix being unbalanced to high risk and reduced volumes were surprising.
Certainly, these findings naturally beg to ask the question, "Can we utilize these strategies to improve outcomes in the congenital cardiac catheterization laboratory?"The answer to this question may prove much more difficult than one might initially believe.Several confounders to this observed outcome improvement exist, including reduced overall case volume.As the core group of performing interventionalists remained the same in each period examined, the requirement for prereview and discussion of necessity was heightened during the first wave of COVID.Resource allocation undoubtedly varied among institutions, but nationally, the need to prioritize emergent procedures and largely pause on elective cases during the first wave was necessary in both congenital and adult catheterization laboratories. 2Prereview with attention paid to acuity and risk was required to allow resource allocation throughout hospital systems of varying degree.This act alone likely had a significant impact.As case volume increases and tasks per individual involved increase, the likelihood of knowing the case complexity more superficially also increases.During high-risk procedures, reduction of risk can be seen with intimacy of details to prevent and rescue from poor outcomes.The focus and attention paid to 1 case compared to several more likely proves valuable as well although this requires additional investigation.
Interestingly, these findings have not been shown in adult interventional laboratories where, during the COVID-19 pandemic period, mortality was noted to increase for individuals who underwent percutaneous interventional procedures. 3One must admit, however, the general burden COVID placed on adult facilities was much higher than that on pediatric From the Children's Healthcare of Atlanta Cardiology, Department of Pediatrics, Atlanta, Georgia, USA.
The author attests he is in compliance with human studies committees and animal welfare regulations of the author's institution and Food and Drug Administration guidelines, including patient consent where appropriate.For more information, visit the Author Center.centers, and the viral effect on patient comorbidities cannot be discounted.
As we enter into a "long" COVID period, supply chain issues persist, particularly in the cardiac catheterization laboratory.Scarcity in resources result in the use of less-than-ideal materials and may result in higher complications as we move forward.During the first wave of COVID, we experienced shortage of materials used by all in the health care profession, such as gloves, masks, and gowns.
However, it took some time into the post-first-wave period for the materials utilized for specialized care to become scarce.Balloons, wires, catheters, and even contrast have proven to be in limited supply, resulting in our field, in particular, utilizing supplies in an even more creative fashion.Already, the congenital space must use materials an off-label fashion, but the current era of supply chain concerns increases our need for creativity, utilizing materials not intended for that particular use.While we have for decades been successful in this task of resourcefulness, this does often result in less-thandesirable outcomes if an item is too long (ie, length of balloon for angioplasty) or too large (ie, need for larger access for intervention in small patients) and can increase complication rates.The full effect of this is yet to be seen.
In addition, we are now facing staffing shortages throughout the country. 4

FUNDING SUPPORT AND AUTHOR DISCLOSURES
Dr Bauser-Heaton is a proctor for W.S. Gore.

R E F E R E N C E S
ISSN 2772-963X https://doi.org/10.1016/j.jacadv.2022.100150*Editorials published in JACC: Advances reflect the views of the authors and do not necessarily represent the views of JACC: Advances or the American College of Cardiology.
N D A T I O N .T H I S I S A N O P E N A C C E S S A R T I C L E U N D E R T H E C C B Y L I C E N S E ( h t t p : / / c r e a t i v e c o m m o n s .o r g / l i c e n s e s / b y / 4 .0 / ) .