Mortality after cardiovascular surgery and procedures during the COVID-19 pandemic in Ontario, Canada: a retrospective cohort study

Background — COVID-19 disrupted global healthcare delivery, but its impact on cardiovascular procedure volumes and outcomes remains unclear. We compared rates and outcomes of coronary artery bypass grafting (CABG), isolated open valve (iValve) surgery, combined CABG and valve, other cardiac surgeries, transcatheter aortic valve implantation (TAVI), and percutaneous coronary intervention (PCI) before and during the pandemic.

Methods — This retrospective cohort study used ICES health administrative data to identify all adults (aged ≥ 18 years) with Ontario Health Insurance Plan coverage who underwent cardiac surgery, TAVI, or PCI between April 2018 and March 2022. The primary outcomes—procedure rates and 30-day all-cause mortality—were compared between the pre-COVID period (April 1, 2018-March 31, 2020) and the COVID period (April 1, 2020-March 31, 2022), the latter using multivariable logistic regression. Secondary outcomes included hospital length of stay and 30-day readmission.

Results — A total of 41,511 cardiac surgeries, 7138 TAVIs, and 86,549 PCIs were analyzed. During the COVID period, procedure rates declined for CABG (−18.8%), iValve (−19.3%), and PCI (−14.7%), whereas TAVI rates increased by 21.4%. Adjusted 30-day mortality increased for CABG (1.92 [95% confidence interval [CI] 1.69-2.15] to 2.25 [95% CI 2.01-2.49] per 100 procedures; P = 0.043), iValve (2.25 [95% CI 1.78-2.71] to 3.29 [95% CI 2.76-3.82]; P = 0.016), and PCI (2.41 [95% CI 2.28-2.54] to 2.74 [95% CI 2.60-2.88]; P < 0.001), but remained stable for TAVI. One excess death during the COVID period occurred per 303 CABGs, 96 iValves, and 303 PCIs.

Conclusions — Although CABG, iValve, and PCI volumes declined and 30-day mortality increased during the pandemic, the absolute number of additional deaths remained small.