Table 1.

Guiding statement for patient triage during tier 1 (0%-30% inpatient COVID-19 load, mild reduction in operative capacity)

Tier 1
Essential services	Deferred
•All inpatients waiting for surgery, including emergency services (ie, ascending aortic dissections, acute coronary syndromes, acute valvular endocarditis, and heart failure patients awaiting heart transplant or VAD) • Outpatients who are at greatest risk of adverse event, examples of which include: ○ Symptomatic critical aortic stenosis ○ CAD ▪ Severe CAD with large territory of myocardium at risk ▪ Asymptomatic CAD with reduced systolic function ▪ Progressive angina ○ Cardiac tumors at risk of obstruction or embolization ○ Aortic aneurysm at risk based on size and familial association ○ Patients with correctable, anatomic causes of heart failure (valvular or myocardial; ie, HCM, adult congenital) ○ End-stage heart failure patients in evaluation for mechanical assist devices who are inotrope dependent	•Asymptomatic outpatients • Truly elective intervention could include: ○ Asymptomatic or minimally symptomatic severe MR ○ ASD or PFO surgery, or both ○ Asymptomatic aneurysm with demonstrated stable size ○ Isolated arrhythmia procedures
►Programs are encouraged to adopt a mechanism by which patients can be screened regularly in order to identify those having increased symptoms or progression of disease ►Transcatheter interventions will follow the same recommendations ►Alternative percutaneous therapies with rapid discharge from the hospital should be considered ►Thoracic organ transplant guidance is provided by the United Network for Organ Sharing

VAD, Ventricular assist device; CAD, coronary artery disease; HCM, hypertrophic cardiomyopathy; MR, mitral regurgitation; ASD, atrial septal defect; PFO, patent foramen ovale.