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), 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) 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 (April 1, 2018–March 31, 2020) and COVID (April 1, 2020–March 31, 2022) periods, 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, 7,138 TAVIs, and 86,549 PCIs were analyzed. During COVID, procedure rates declined for CABG (−18.8%), iValve (−19.3%), and PCI (−14.7%), while TAVI rates increased by 21.4%. Adjusted 30-day mortality increased for CABG (1.92 [95% CI, 1.69–2.15] to 2.25 [2.01–2.49] per 100 procedures; p=0.043), iValve (2.25 [1.78–2.71] to 3.29 [2.76–3.82]; p=0.016), and PCI (2.41 [2.28–2.54] to 2.74 [2.60–2.88]; p