COVID-19 and Fontan: bioethical analysis derived from the need for hospital reconversion

Abstract

Background: Among congenital heart diseases, those with univentricular physiology are the most severe with the lowest survival. Fontan surgery (FS) is the procedure of choice, as it bypasses the flow from the caval veins to the pulmonary circulation but requires close monitoring for late complications. The SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) pandemic caused nations to prioritize the availability of human and material health resources to benefit those infected. This study aimed to evaluate the clinical consequences of hospital reconversion due to the COVID-19 pandemic in a univentricular heart clinic for patients with FS from the bioethical perspective. Methods: We conducted an analytical cross-sectional study in a captive cohort of patients with FS treated in a tertiary hospital with conversion to COVID-19 patient care. The consequences of discontinuation of follow-up were recorded. Qualitative variables were expressed as frequencies and percentages, and quantitative variables as medians and interquartile ranges (p25-p75). Comparison between the two groups was performed with the χ2 test. Results: We included 51 patients with a median age of 13 years and a follow-up of 5 years. The male: female ratio was 0.88:1.12, and 41% (21) presented failures. More than 90% of the patients presented needs for medications and imaging studies. The two patients cared for in palliative care discontinued their care. Conclusions: Continuity of care must be guaranteed for all patients who require it, so health policies are needed to ensure compliance with vulnerable groups.

Keywords

• COVID-19. Congenital heart diseases. Fontan surgery. Pediatric. Mexico. Bioethics.