Impact of Coronavirus Disease 2019 (COVID‐19) on Patients With Congenital Heart Disease Across the Lifespan: The Experience of an Academic Congenital Heart Disease Center in New York City

Abstract

Background We sought to assess the impact and predictors of Coronavirus Disease 2019 (COVID‐19) infection and severity in a cohort of congenital heart disease (CHD) patients at a large CHD center in New York City. Methods and Results We performed a retrospective review of all individuals with CHD followed at Columbia University Irving Medical Center who were diagnosed with COVID‐19 between 3/1/2020 and 7/1/2020. The primary endpoint was moderate/severe response to COVID‐19 infection defined as a) death during COVID‐19 infection; or 2) need for hospitalization and/or respiratory support secondary to COVID‐19 infection. Among 53 COVID‐19 positive patients with CHD, 10 (19%) were <18 years old (median age 34 years). 31 (58%) had complex congenital anatomy including 10 (19%) with a Fontan repair. Eight (15%) had a genetic syndrome, six (11%) had pulmonary hypertension (PH), and nine (17%) were obese. Among adults, 18 (41%) were physiologic class C or D. For the entire cohort, nine (17%) had a moderate/severe infection, including three deaths (6%). After correcting for multiple comparisons, the presence of a genetic syndrome (OR=35.82: p=0.0002), and in adults, physiological Stage C or D (OR=19.38: p=0.002) were significantly associated with moderate/severe infection. Conclusions At our CHD center, the number of symptomatic COVID‐19 patients was relatively low. CHD patients with a genetic syndrome and adults at advanced physiological stage were at highest risk for moderate/severe infection.

Reply to Letter: factors affecting COVID-19 outcomes in patients with congenital heart disease

“…In specific response to their cited article by Lewis et al, the results of which they claim to be contrary to our findings, we proffer that a single study cannot be used to generalize outcomes over a large population of CHD patients [7]. Furthermore, their finding of lacking the correlation between the complexity of CHD and the severity of infection-related cardiac decompensation does not disqualify CHD from being a predictor of worse prognosis in itself.…”

Coronavirus disease 2019 in patients with Fontan circulation

“…Our data are in line with the positive outcome described in 10 Fontan patients in a single-centre US study 6 . These results may be partially explained with the observation that, despite the above-described multiple implications of Covid-19, patients with single-ventricle might be protected by younger age, patients’ education to self-isolation and chronic treatment with anticoagulants/antiplatelets, which were showed to improve the outcome 7 , 8 Interestingly, according to the 2018 ACC/AHA ACHD guidelines 9 , 6 out of 7 patients in our study had an advanced physiological stage, which was reported as a risk factor of adverse outcome in ACHD patients5. Patients with failing Fontan or unstable haemodynamics may be at higher risk of complications from Covid-19.…”

COVID-19 in Adults With Congenital Heart Disease

“…As such, they have largely been considered high risk and often adopt a highly restrictive lifestyle and employment choices accordingly. Early publications in CHD reported different risks ( 7 , 8 ) but suggested worse risk in higher physiological stages ( 9 ).…”