Impact of early surgical correction or palliation of congenital heart defects in infants with symptomatic viral respiratory tract infections in the current era

Abstract

Objective: This study investigates the influence of timing of surgery among infants with congenital heart disease and active respiratory tract infections in a contemporary Western Canadian cohort.

Methods: This was a retrospective matched cohort study of infants aged 1 week to 6 months undergoing surgical repair of congenital heart disease between 2014 and 2017. Case patients had active respiratory tract infections preoperatively and were matched to control patients based on primary heart lesion. The primary outcome was time to extubation.

Results: We identified 20 cases (median age, 3.4 months [range, 2.4-4.3 months]) that were matched to 40 controls (1:2 ratio). In case patients, surgery occurred at a median of 1 day after the positive viral testing. There were no statistically significant differences between cases and controls in time to extubation (59 vs 34 hours [P = .12]), postoperative vasoactive scores at 24 hours (0 vs 0 [P = .53]), 48 hours (0 vs 0 [P = .23]), maximum vasoactive score in postoperative period (5 vs 5.5 [P = .54]), or time to hospital discharge (13 vs 12 days [P = .39]). Case patients had increased duration of total respiratory support (including noninvasive ventilation, 3.5 vs 2 days [P = .02]) and postoperative intensive care unit length of stay (5.5 vs 3 days [P = .01]).

Conclusions: Cardiac surgery on infants with congenital heart disease during an acute viral respiratory tract infection may yield a clinically relevant prolongation in time to extubation.

Keywords: CHD, congenital heart disease; ICU, intensive care unit; NPA, nasopharyngeal aspirate; PCICU, pediatric cardiac intensive care unit; RSV, respiratory syncytial virus; RTI, respiratory tract infection; VIS, vasoactive inotropic score; WCCHN, Western Canadian Congenital Heart Network; congenital heart disease; intensive care units; pediatrics; postoperative outcomes; viral respiratory tract infections.

Graphical abstract

Infants with RTI undergoing surgical repair of CHD: Time to extubation versus controls.

Figure 1

Case patients (aged 1 week to 6 months) were identified from the Western Canadian Congenital Heart Network (WCCHN) and cross referenced against positive nasopharyngeal aspirate (NPA) results within 4 weeks of surgery date. Patients with no description of clinical symptoms in the medical record were excluded. Control patients were identified from the WCCHN registry based on surgical intervention and without symptoms of viral respiratory tract infection (RTI). NICU, Neonatal intensive care unit.

Figure 2

Background, study methods, and study conclusions. Infants (aged 1 week to 6 months) with congenital heart disease and active and viral respiratory tract infections (RTIs) preoperatively were matched in a 1:2 fashion to controls based on predominant heart lesion. Viral RTI cases were found to have a statistically insignificant, although clinically relevant increase in time to extubation compared with matched controls. Case patients also had an increased intensive care (ICU) length of stay and total duration of respiratory support (total time of intubation plus noninvasive support).