Congenital heart surgery in children remained safe during the Covid-19 pandemic

Congenital heart surgery in children remained safe during the Covid-19 pandemic

Significant reallocation of healthcare services during the Covid-19 pandemic resulted in a significant reduction in elective surgery for children with congenital heart disease (CHD), allowing those in need of urgent, life-saving and emergency surgery to be treated. However, this prioritization of the sickest children has not increased postoperative complication rates or death, a study led by the University of Bristol has shown.

The research, published inOpen heartsuggests that prioritization of operations may be appropriate in younger and more critical children when there is a sudden disruption to usual care. The results could be used as a preparedness model for future pandemic scenarios such as natural disasters or healthcare disruptions.

In the early days of the SARS-COV-2 pandemic, pressure on healthcare resources impacted hospitals to treat CoVID-19 patients and postpone elective procedures such as specialty surgeries for CHD in children. However, CHD children require multiple repeat surgeries to maintain healthy heart structure and functions as they grow.

The aim of the study was to assess the impact on CHD procedures in England during different pandemic periods compared to the pre-pandemic period in children under 16 years of age, to inform appropriate responses to future serious health conditions. Researchers also examined whether post-procedure complications and post-procedure death increased during these periods compared to the pre-pandemic period.

Researchers analyzed 26,270 procedures among 17,860 children between January 1, 2018 and March 31, 2022 in England and linked them to primary/secondary care data. The study period included pre-pandemic and pandemic phases, the latter containing three restriction periods and corresponding relaxation periods. The procedural characteristics and outcomes between each pandemic period and the pre-pandemic period were compared.

The study found that the average number of CHD procedures per week was lower during all pandemic periods compared to pre-pandemic levels. The largest reductions occurred during the first, most severe restrictions and the relaxation period following the second restrictions, coinciding with winter pressures.

These reductions were primarily driven by reductions in elective procedures, while urgent and emergency/life-saving procedures remained stable compared to pre-pandemic rates. There was evidence of prioritizing cardiac surgery before catheterization and prioritizing infants during the pandemic. Reassuringly, research found limited evidence of increased post-procedure complications or deaths during the pandemic compared to pre-pandemic levels.

Dr. Arun Karthikeyan SUSELADEVI, Senior Research Associate in Medical Statistics and Health Data Science in the Bristol Medical School: Population Health Sciences (PHS), said: “Our findings suggest that when pressures on health services lead to prioritization, urgent, emergency and life-saving procedures in children with CHD and the delay in time lead to increased justification after two years.

“These findings have implications for the future delivery of healthcare services, particularly during infectious disease epidemics or global pandemics, as well as extreme weather events common across Europe.

"Specifically, during the relaxation period following the second restriction, median rates of total and elective procedures fell to levels similar to those in the first restriction period, exceeding the reductions observed during the second restriction. This second relaxation occurred in winter (December 3, 2020 to January 5, 2021) and may reflect winter pressures.

“If climate change increases the frequency of extreme weather events, such pressures are likely to increase, highlighting the need for climate change mitigation strategies and effective plans to manage health service pressures from multiple sources.”

These results are reassuring and a warning that they cannot tell us what happened to individual patients. In particular, we need to examine what longer-term impact it might have on the children whose surgery was delayed and their families. As we continue to collect more informational data, we hope to be able to determine whether these children and their families experienced adverse cardiac or psychological effects from the delayed surgery. “

Professor Deborah Lawlor, British Heart Foundation Professor of Cardiovascular Science and lead author on the paper

Massimo Caputo, professor of congenital heart surgery, and an author on the paper, added: "We also need to understand the impact of Covid-19 infection on children with CHD, especially those who have undergone surgery and may have been exposed to the infection in hospital."

The study was supported by the British Heart Foundation Data Science Center led by HDR UK (BHF Grant No. SP/19/3/34678), NIHR Bristol Biomedical Research Center (BRC) and MRC Integrative Epidemiology Unit (IEU). The study uses de-identified data held in NHS England's secure data environment service for England and available through the BHF Data Science Center CVD-Covid-UK/Covid-Impact consortium.

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