The number of people infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) worldwide is increasing dramatically [1], and reports from China, Iran, Italy and other areas hit hard by SARS-CoV-2 are chilling. The metropolitan area of Milan and its surrounding region of the Lombardy are one of the worst affected in Italy, and Europe at the moment. As of 29 March 2020, there have been 97 689 cases with 10 779 fatalities due to COronaVIrus Disease 2019 (COVID-19) in whole of Italy; of these, 41 007 (6360 fatalities) have occurred in Lombardy region [2]. In order to slow down viral transmission, local authorities and the Italian government have imposed strong containment measures by quarantining initial COVID-19 clusters and followed by a complete nationwide lock-down. The exponential increase in COVID-19-positive patients and the dramatically increasing need for intensive care unit (ICU) surge capacity for the management of critically ill patients has led the emergency task force of the Lombardy region to reallocate ICU resources [3]. In addition, elective surgery has been cancelled and beds dedicated to cardiac, neurosurgery and partially coronary care units reassigned to COVID-19-patients. For this reason, 16 of the 20 cardiac surgical units in the Lombardy region have discontinued their activities, with the remaining 4 units forming ‘the hub’ for the 16 other closed units (spokes). In this hub-and-spoke system, all urgent and emergency cases are sent to these 4 units, including those that cannot be delayed for more than 60 days. Moreover, beds for critically ill patients are also obtained from the reconversion of operation and recovery rooms (A. Parolari, personal communication).