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Research and media reports about coronavirus disease 2019 (COVID-19) have largely focused on urban areas due to their high caseloads. However, the COVID-19 pandemic presents distinct and under-recognized challenges to rural areas. This report describes the challenges faced by Bassett Healthcare Network (BHN), a health network in rural upstate New York, and the strategies BHN devised in response. The response to COVID-19 at BHN focused on 4 strategies: (1) Expansion of intensive-care capacity. (2) Redeployment and retraining of workforce. (3) Provision of COVID-19 information, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral testing, and appropriate follow-up for a geographically dispersed population. (4) Coordination of the response to the pandemic across a large, diverse organization. Rural health systems and hospitals can take steps to address the specific challenges posed by the COVID-19 pandemic in their communities. We believe that the strategies BHN employed to adapt to COVID-19 may be useful to other rural health systems. More research is needed to determine which strategies have been most effective in responding to the pandemic in other rural settings.

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Objective Existing aortic graft complicates the surgical management of prosthetic valve endocarditis, yet its impact has not been well studied. We compared outcomes of patients with prior aortic valve replacement versus aortic surgery plus aortic valve replacement, who underwent reoperative aortic root replacement for prosthetic valve endocarditis of the aortic valve. Methods All patients who underwent reoperative aortic root replacement for prosthetic valve endocarditis between 2004-2021 from 2 aortic centers were included. Two groups were formed based on presence/absence of aortic graft: prior aortic surgery (AO) and prior aortic valve replacement alone (AV). Inverse propensity treatment weighting matched groups. Kaplan-Meier method analyzed long-term survival, and Fine and Gray model compared cumulative incidence of reoperation. Results A total of 130 patients were included (AO n = 59; AV n = 71). After matching, AO patients had increased stroke incidence (12.4% vs 0.9%) and renal failure requiring dialysis (11.5% vs 2.5%). In-hospital mortality was comparable (21.5% AO and 18.6% AV). Survival over 5 years was 68.9% (56.6-83.8%) in AO and 62.7% (48.1-81.7%) in AV (p = 0.70). Cumulative incidence of reoperation was similar [AO 6.3% (0.0-13.2%) vs AV 6.1% (0.0-15.1%), p = 0.69]. Conclusions Reoperative aortic root replacements for prosthetic valve/graft endocarditis are high-risk procedures. AO patients had higher incidence of post-operative morbidity versus AV patients. For all patients surviving operative intervention, survival and reoperation rates over 5 years were comparable between groups.