Positive viral PCR test may not contraindicate cardiac surgery

All by itself, preoperative identification of viral bronchiolitis by polymerase chain reaction (PCR) does not predict increased morbidity or mortality, according to a retrospective review that compared outcomes in patients with virus detected by PCR on nasopharyngeal swabs at the time of surgery with outcomes in patients who tested viral negative. Participants included a group of single-ventricle patients and a group of 2-ventricle patients, all of whom were PCR viral positive but had only mild symptoms or were largely asymptomatic; both groups had cardiac surgery without postponement. The 2 control groups comprised age-and procedure-matched patients who were viral negative at the time of surgery or had no clinical indication warranting respiratory viral testing. Investigators found no statistical difference between the 81 patients with 2 ventricles in the viral-positive group and the control group regarding extubation in the operating room, reintubation, hospital length of stay, or mortality. Similarly, the 36 single-ventricle, viral-positive patients showed no differences in any outcome variable compared with the control group.

Thoughts from Dr. Farber

When I first started pediatrics, routine preoperative testing included a complete blood count, urinalysis, and often a chest x-ray. We eventually learned that this was worthless in the child who had no clinical indications for testing. The wheel reinvents itself here. Testing for viruses in the not very ill child is not of benefit, even with high-risk surgery.

Reference

1.Cox VK, Hersey D, Valentine M, et al. Impact of viral PCR positive nasal swabs (non Covid-19) on outcomes following cardiac surgery. Pediatr Cardiol. 2021.13;1-5. Published online May 13, 2021. doi:10.1007/s00246-021-02636-8