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Coronavirus disease 2019 convalescent children: outcomes after congenital heart surgery
Shreedhar S Joshi1, Manaswini Keshava2, Keshava S Murthy1
1Department of Anaesthesia and Intensive Care, Narayana Institute of Cardiac Sciences, Bangalore, India.
Insights
Children with prior COVID-19 infection (coronavirus disease 2019) undergoing congenital heart surgery show similar outcomes to those without the infection. Post-operative results, including mortality and complications, were comparable between convalescent and control groups.
Area of Science:
- Pediatric Cardiology
- Infectious Diseases
- Surgical Outcomes
Background:
- Increasing numbers of children with prior coronavirus disease 2019 (COVID-19) exposure are undergoing congenital heart surgery.
- Understanding outcomes in these pediatric patients is crucial for risk stratification and pre-surgical optimization.
Purpose of the Study:
- To determine if children with convalescent COVID-19 have worse mortality or post-operative outcomes after congenital heart surgery.
- To compare outcomes between COVID-19 convalescent and non-exposed children undergoing congenital heart surgery.
Main Methods:
- Consecutive children undergoing congenital heart surgery (Oct 2020-May 2021) were tested for COVID-19 (PCR/antigen and IgG).
- Convalescent COVID-19 was defined as asymptomatic, IgG positive, and PCR/antigen negative within 6 weeks prior to surgery.
- Outcomes including mortality, ventilation duration, ICU/hospital stay, and infections were compared between convalescent and control groups.
Main Results:
- Of 1129 surgeries, 349 were in the COVID-19 convalescent group and 780 in the control group.
- No significant differences in mortality, ventilation duration, ICU/hospital stay, or need for ECMO/HFNC were observed.
- Infection rates (CLABSI, SSI, VAP) and re-intubation/re-admission rates were similar between groups.
Conclusions:
- Convalescent COVID-19 in children does not appear to lead to unfavorable outcomes after congenital heart surgery.
- Positive IgG antibody screening prior to surgery suggests convalescence and supports comparable outcomes to non-exposed peers.
Background:
Children with exposure to coronavirus disease 2019 in recent times (asymptomatic or symptomatic infection) approaching congenital heart surgery programme are in increasing numbers. Understanding outcomes of such children will help risk-stratify and guide optimisation prior to congenital heart surgery.
Objective:
The objective of the present study was to determine whether convalescent coronavirus disease 2019 children undergoing congenital heart surgery have any worse mortality or post-operative outcomes.
Design:
Consecutive children undergoing congenital heart surgery from Oct 2020 to May 2021 were enrolled after testing for reverse transcription-polymerase chain reaction or rapid antigen test and immunoglobulin G antibody prior to surgery. Convalescent coronavirus disease 2019 was defined in any asymptomatic patient positive for immunoglobulin G antibodies and negative for reverse transcription-polymerase chain reaction or rapid antigen test anytime 6 weeks prior to surgery. Control patients were negative for any of the three tests. Mortality and post-operative outcomes were compared among the groups.
Results:
One thousand one hundred and twenty-nine consecutive congenital heart surgeries were stratified as convalescence and control. Coronavirus disease 2019 Convalescent (n = 349) and coronavirus disease 2019 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 extracorporeal membrane oxygenation, high flow nasal cannula, no higher need for re-intubations, re-admissions, and no higher infections as central line-associated bloodstream infection, sternal site infection, and ventilator-associated pneumonia on comparison with coronavirus disease 2019 control children.
Conclusions:
Convalescent coronavirus disease 2019 does not have any unfavourable outcomes as compared to coronavirus disease 2019 control children. Positive immunoglobulin G antibody screening prior to surgery is suggestive of convalescence and supports comparable outcomes on par with control peers.
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