The pandemic of coronavirus disease 2019 (COVID-19) has increased hospital resource use and necessitated postponing non-urgent heart surgical procedures. Researchers wanted to document regional variations in adult cardiac surgery case volume and case mix in North America during the first wave of the COVID-19 epidemic. Researchers sent a survey to adult cardiac surgery centers in North America to see whether they wanted to participate. They studied the volume and mix of cardiac surgery cases at the institutional and regional levels. The analysis includes 67 adult cardiac surgery institutes from North America, with yearly case volumes of 60,452 in 2019. In most institutions (96 %), nonurgent surgery was stopped in March 2020, resulting in a drop to 45 % of baseline with significant regional variation. Hospitals with a high burden of COVID-19-infected patients showed similar patterns in overall volume drop as centers with a low load. There was a relative increase in coronary artery bypass grafting surgery (high +7.2 % vs. low +4.2 %, P =.550), extracorporeal membrane oxygenation (high +2.5 % vs. low 0.4 %, P =.328), and heart transplantation (high +2.7 % vs. low 0.4 %, P =.090), as a proportion of total surgical volume, and a decline in valvular cases (high –7.6 % vs. low The current analysis reveals the influence of COVID-19 on North American cardiac surgery facilities, as well as assisting in the correlation of area and COVID-19 burden with cardiac surgery volumes and case mix.