COVID-19 convalescent children – outcomes after congenital heart surgery

Background – Children with exposure to COVID-19 in recent times (asymptomatic or symptomatic infection) approaching congenital heart surgery (CHS) program are in increasing numbers. Understanding outcomes of such children will help risk-stratify and guide optimization prior to CHS. Objective: The objective of the present study was to determine whether convalescent COVID-19 children undergoing congenital heart surgery have any worse mortality or postoperative outcomes. Design: Consecutive children undergoing CHS from Oct 2020 to May 2021 were enrolled after testing for RT-PCR (Reverse Transcriptase Polymerase chain test) or rapid antigen test (RAT) and IgG antibody prior to surgery. Convalescent COVID-19 was defined in any asymptomatic patient positive for IgG antibodies and negative for RT-PCR or RAT anytime 6 weeks prior to surgery. Control patients were negative for any of the three tests. Mortality and postoperative outcomes were compared among the groups. Results: 1129 consecutive CHS were stratified as convalescence and control. COVID-19 Convalescent (n=349) and COVID-19 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 ECMO, HFNC, no higher need for re-intubations, re-admissions, and no higher infections as CLABSI, SSI, and VAP on comparison with COVID-19 control children. Conclusions: Convalescent COVID-19 do not have any unfavorable outcomes as compared to COVID-19 control children. Positive IgG antibody screening prior to surgery is suggestive of convalescence and supports comparable outcomes on par with control peers.