The Heart Center at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.
Pediatr Cardiol. 2021 Oct;42(7):1526-1530. doi: 10.1007/s00246-021-02636-8. Epub 2021 May 13.
Viral bronchiolitis is a relative contraindication to elective pediatric cardiac surgery. Nasopharyngeal swab utilizing polymerase chain reaction (PCR) screening for viruses known to cause bronchiolitis are commonly available. The objective of this study was to evaluate clinical outcomes in patients with nasopharyngeal viral PCR positive findings at the time of cardiac surgery. Retrospective review from January 2013 to May 2019 for patients with virus detected by PCR on nasopharyngeal swabs at the time of cardiac surgery. Single ventricle and two ventricle patients were compared to control group of age and procedure matched patients viral negative at the time of surgery. Outcome measures included OR extubation, reintubation, hospital length of stay, and mortality. For two ventricle patients (n = 81; control group = 165), there was no statistical difference in any outcome variable (OR extubation 74% vs 72%; p = 0.9; reintubation 9% vs 11% vs; p = 0.7; hospital length of stay 5 days (1-46) vs 4 days (2-131); p = 0.4; mortality 2 vs 1; p = 0.3). For single ventricle patients, there was no statistical difference in any outcome variable (OR extubation 81% vs 76%; p = 0.6; reintubation 14% vs 21% vs; p = 0.5; hospital length of stay 9.5 days (3-116) vs 15 days (2-241); p = 0.1; mortality 0 vs 3; (p = 0.6)). PCR is a sensitive test that fails to predict which patients will proceed to have a clinically significant infection. Viral bronchiolitis remains a relative risk factor for cardiac surgery; presence of detectable virus via nasopharyngeal swab with limited clinical symptoms may not be a contraindication to cardiac surgery.
病毒性细支气管炎是小儿心脏手术的相对禁忌证。目前常用聚合酶链反应（PCR）检测鼻咽拭子中已知引起细支气管炎的病毒，以进行病毒筛查。本研究的目的是评估心脏手术时鼻咽部病毒 PCR 阳性患者的临床结局。对 2013 年 1 月至 2019 年 5 月期间，心脏手术时鼻咽拭子 PCR 检测到病毒的患者进行回顾性分析。将单心室和双心室患者与手术时病毒阴性且年龄和手术方式相匹配的对照组患者进行比较。观察指标包括有创机械通气时间、再次插管、住院时间和死亡率。对于双心室患者（n=81；对照组 n=165），两组患者在任何转归变量上均无统计学差异（有创机械通气时间：74% vs 72%；p=0.9；再次插管：9% vs 11%；p=0.7；住院时间：5 天（1-46） vs 4 天（2-131）；p=0.4；死亡率：2 例 vs 1 例；p=0.3）。对于单心室患者，两组患者在任何转归变量上均无统计学差异（有创机械通气时间：81% vs 76%；p=0.6；再次插管：14% vs 21%；p=0.5；住院时间：9.5 天（3-116） vs 15 天（2-241）；p=0.1；死亡率：0 例 vs 3 例；p=0.6）。PCR 是一种敏感的检测方法，但不能预测哪些患者会发生具有临床意义的感染。病毒性细支气管炎仍然是心脏手术的相对危险因素；对于心脏手术时存在通过鼻咽拭子检测到的病毒，且具有有限的临床症状的患者，病毒检测阳性可能不是心脏手术的禁忌证。
