VIRAL RESPIRATORY INFECTION, A RISK IN PEDIATRIC CARDIAC SURGERY: A PROPENSITY-MATCHED ANALYSIS

Li X, Wang X, Li S, Zeng M, Li D. Pediatr Crit Care Med. 2020;21(7):e431-e440. DOI: 10.1097/PCC.0000000000002308

In this retrospective study of children undergoing cardiac surgery, the researchers' objectives were (1) to describe the postoperative course and outcomes of cardiac surgery in children with perioperative viral respiratory infection (VRI), (2) to evaluate whether timing of surgery has any impact on the patient outcomes, and (3) to explore the risk factors of death to identify risk stratification. Current research finds that patients with congenital heart disease who have a VRI may have a higher morbidity, mortality, and hospitalization rate as compared with non-congenital heart disease patients. In addition, VRI is a contraindication for elective cardiac surgery in children and contributes to delayed surgeries. This was a single-facility research project. In this facility, respiratory virus polymerase chain reaction testing was routinely done in patients younger than 2 years. For this study, children (n = 2831) admitted between January 1, 2014, and December 31, 2016, who had the polymerase chain testing and cardiac surgery were included.

The researchers found that of the 2831 children tested, viruses were detected in 3.2% (n = 91) of the patients; 35 were preoperative patients and 56 were postoperative patients. Of the preoperative patients who tested positive, 29 had surgery postponed until any symptoms of a respiratory illness were resolved and they had a negative polymerase chain reaction. Six of the 35 had cardiac surgery before the resolution of symptoms. There were a total of 7 deaths. The authors concluded that the preoperative-unresolved and postoperative respiratory viral rates were associated with prolonged recovery, increased severity, and mortality in children who required cardiac surgery. They also found that palliative surgeries were associated with increasing mortality.