Coronavirus disease 2019 convalescent children: outcomes after congenital heart surgery

Abstract

Background – Children with exposure to COVID-19 in recent times (asymptomatic or symptomatic infection) approaching congenital heart surgery (CHS) program are in increasing numbers. Understanding outcomes of such children will help risk-stratify and guide optimization prior to CHS. Objective: The objective of the present study was to determine whether convalescent COVID-19 children undergoing congenital heart surgery have any worse mortality or postoperative outcomes. Design: Consecutive children undergoing CHS from Oct 2020 to May 2021 were enrolled after testing for RT-PCR (Reverse Transcriptase Polymerase chain test) or rapid antigen test (RAT) and IgG antibody prior to surgery. Convalescent COVID-19 was defined in any asymptomatic patient positive for IgG antibodies and negative for RT-PCR or RAT anytime 6 weeks prior to surgery. Control patients were negative for any of the three tests. Mortality and postoperative outcomes were compared among the groups. Results: 1129 consecutive CHS were stratified as convalescence and control. COVID-19 Convalescent (n=349) and COVID-19 control (n=780) groups were comparable for all demographic and clinical factors except younger and smaller kids in control. Convalescent children had no higher mortality, ventilation duration, ICU and hospital stay, no higher support with ECMO, HFNC, no higher need for re-intubations, re-admissions, and no higher infections as CLABSI, SSI, and VAP on comparison with COVID-19 control children. Conclusions: Convalescent COVID-19 do not have any unfavorable outcomes as compared to COVID-19 control children. Positive IgG antibody screening prior to surgery is suggestive of convalescence and supports comparable outcomes on par with control peers.

Surgical outcomes in children with congenital heart disease after SARS-CoV-2 Omicron variant infection: a single-center case-control study

“…Another interesting nding in this study was the recurrence of SARS-CoV-2 after surgeries, which was not reported by previous CHD reports [16,17,21,22]. The recurrence rate was as high as 20% (8/40), and all recurrences were detected by re-positive nucleic acid tests on the day of surgery after patients were admitted to the ICU.…”

“…In an early international cohort study of outcomes in adult patients undergoing surgery with perioperative SARS-CoV-2 infection [14], the 30-day mortality was as high as 23.8%, and pulmonary complications occurred in 51.2% of patients. Later, it was suggested that surgery should be delayed for at least 7 weeks following SARS-CoV-2 infection [15], and several small-sample studies have suggested that surgical timing in children with CHD be delayed for at least 2 to 6 weeks [16][17][18].…”

Infection with the SARS-CoV-2 Omicron variant in children with congenital heart disease: A case series study during Shanghai epidemic

“…They were able to meet the discharge criteria at 22, 11, and 14 days. At present, there are several reports on the treatment of critically ill CHD after negative nucleic acid testing for SARS-CoV-2 ( 27 ) and surgical treatment in the recovery period for SARS-CoV-2 ( 28 ). These studies have a positive effect on exploring the reasonable timing of surgery in children with CHD during the SARS-CoV-2 outbreak.…”

Timing of Surgery in Patients with Novel Coronavirus Infection: Basing on Current Epidemiological Characteristics and The Impact on Physiological Functions

“…In a study of children undergoing surgery for congenital heart disease, no difference was found in the incidence of postoperative complications between COVID-19 positive children who underwent surgery 6 weeks after recovery and COVID-19 negative children. [11] Required surgery…”