Surgical outcomes in children with congenital heart disease after SARS-CoV-2 Omicron variant infection: a single-center case-control study

Abstract Objective To analyze the clinical characteristics and surgical outcomes in children with congenital heart disease (CHD) after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variant infection. Methods A retrospective case‒control study was performed on children with CHD after SARS-CoV-2 Omicron variant infection as a convalescent group at Shanghai Children's Medical Center from Jan 1,2022 to Jan 20,2023. The control group was matched by CHD patients (without SARS-CoV-2 infection) who underwent surgical repair during the same period. Clinical data and outcomes were analyzed and compared between groups. Result A total of 120 CHD patients were included in this study: 40 CHD patients after SARS-CoV-2 infection (convalescent group) and 80 CHD patients without infection (control group). The in-hospital mortality rate was 2.5% (1/40) in the convalescent group. Troponin I values were statistically higher in convalescent group than in control at surgery day after being admitted to intensive care unit(ICU) [6.98 (3.43–14.79)vs. 2.67 (1.38–6.22),p = 0.00] and postsurgery day 1[2.69 (1.17–5.05)vs. 1.56 (0.73–3.40), p = 0.015]. In addition, patients who undergo surgery within 10 days of a negative nucleic acid results (NNAR) were associated with prolonged ICU stay(4.57 ± 3.01 vs 3.06 ± 1.52, p = 0.046). The recurrence rate of SARS-CoV-2 was 20% (8/40) in this study. The cardiopulmonary bypass (CPB) time [98.5 (64.75-289.25) vs. 64.5 (48.5–88), p = 0.010] in recurrence patients was longer than that in patients without recurrence. Moreover, patients with recurrence were associated with longer mechanical ventilation time (72.00 ± 57.32 vs. 21.78 ± 17.83, 0.043) and ICU stay (6.75 ± 3.54 vs. 3.25 ± 1.72, p = 0.027). Conclusion In children with CHD after SARS-CoV-2 Omicron variant infection, myocardial injury after surgery might be more severe. Clinical outcome was without statistical difference if surgeries were performed after 10 days of NNAR. Patients with longer CPB times were likely to suffer recurrence after surgery which may lead to longer MV and ICU time.