Impact of early surgical correction or palliation of congenital heart defects in infants with symptomatic viral respiratory tract infections in the current eraCentral MessagePerspective
Nick A. Giffin, MD, MSc, FRCPC,
Gonzalo Guerra, MD, MSc, PhD, FRCPC,
Joan Robinson, MD, FRCPC,
Chloe Joynt, MD, MSc, FRCPC,
Ivan Rebeyka, MD, FRCSC,
V. Ben Sivarajan, MD, MS, FRCPC
Affiliations
Nick A. Giffin, MD, MSc, FRCPC
Division of Pediatric Emergency Medicine, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
Gonzalo Guerra, MD, MSc, PhD, FRCPC
Pediatric Cardiac Intensive Care Unit, Division of Pediatric Critical Care, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
Joan Robinson, MD, FRCPC
Divsion of Pediatric Infectious Diseases, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
Chloe Joynt, MD, MSc, FRCPC
Division of Neonatology, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
Ivan Rebeyka, MD, FRCSC
Division of Pediatric Cardiac Surgery, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
V. Ben Sivarajan, MD, MS, FRCPC
Pediatric Cardiac Intensive Care Unit, Division of Pediatric Critical Care, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada; Address for reprints: V. Ben Sivarajan, MD, MS, FRCPC, PCICU, Stollery Children's Hospital, University of Alberta, Edmonton Clinic Health Academy, 11405-87 Ave, Edmonton, Alberta T6G 1C9 Canada.
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.
