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| Authors | Date | Title | Study design | Objective | Methods | Results |
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| Moons et al. | 2010 | Temporal trends in survival to adulthood among patients born with congenital heart disease from 1970 to 1992 in Belgium | Retrospective study | To investigate the proportion of CHD patients born between 1990 and 1992 who survived into adulthood and to compare their survival with that of CHD patients born in earlier eras and evaluate survival as a function of the type of heart defect | Authors reviewed the CHD program administrative and clinical database at the university hospitals Leuven (Leuven, Belgium) and analyzed the records of 7497 CHD patients born from 1970 to 1992 | This study demonstrated that almost 90% of children with CHD have the prospect of surviving into adulthood |
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| Huang et al. | 2020 | Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China | Prospective study | To report the epidemiological, clinical, laboratory, and radiological characteristics and treatment and clinical outcomes of COVID-19 patients | All patients with suspected 2019-nCoV were admitted to a designated hospital in Wuhan. Prospectively collected and analyzed data on patients with laboratory-confirmed 2019-nCoV infection by real-time RT-PCR and next-generation sequencing. Data were obtained with standardised data collection forms shared by WHO and the International Severe Acute Respiratory and Emerging Infection Consortium from electronic medical records. Researchers also directly communicated with patients or their families to ascertain epidemiological and symptom data. Outcomes were also compared between patients who had been admitted to the ICU and those who had not | The 2019-nCoV infection caused clusters of severe respiratory illness similar to severe acute respiratory syndrome coronavirus and was associated with ICU admission and high mortality |
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| Broberg et al. | 2021 | COVID-19 in adults with congenital heart disease | Cohort study | This study sought to define the impact of COVID-19 in adults with CHD and to identify risk factors associated with adverse outcomes | Adults (age 18 years or older) with CHD and with confirmed or clinically suspected COVID-19 were included from CHD centers worldwide. Data collection included anatomic diagnosis and subsequent interventions, comorbidities, medications, echocardiographic findings, presenting symptoms, course of illness, and outcomes. Predictors of death or severe infection were determined | COVID-19 mortality in adults with CHD is commensurate with the general population. The most vulnerable patients are those with worse physiological stage, such as cyanosis and pulmonary hypertension, whereas anatomic complexity does not appear to predict infection severity |
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| Ruperti-Repilado et al. | 2021 | Risk stratification of adults with congenital heart disease during the COVID-19 pandemic: insights from a multinational survey among European experts | Cross-sectional study | The study aimed to provide an expert view on risk stratification while awaiting results from observational studies | This study was an initiative of the EPOCH (European Collaboration for Prospective Outcome Research in Congenital Heart) disease. Among nine European countries (Austria, Belgium, Denmark, France, Germany, Italy, the Netherlands, Spain, and Switzerland), 24 experts from 23 tertiary adults with CHD centers participated in the survey. Adults with CHD experts were asked to identify adults with CHD-specific COVID-19 risk factors from a list of potential outcome predictors and to estimate the risk of adverse COVID-19 outcomes in seven commonly seen patient scenarios | Pulmonary arterial hypertension, Fontan palliation, and cyanotic heart disease were widely considered as risk factors for poor outcome in COVID-19. However, there was a marked disparity in risk estimation for other clinical scenarios. We are in urgent need of outcome studies in adults with CHD suffering from COVID-19 |
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| Schwerzmann et al. | 2021 | Clinical outcome of COVID-19 in patients with adult congenital heart disease | Cohort study | The aim of this study was to collect clinical outcome data and to identify risk factors for a complicated course of COVID-19 in adults with CHD | Twenty-five adults with CHD centers in nine European countries participated in the study. Consecutive patients with CHD diagnosed with COVID-19 presenting to one of the participating centers between 27 March and 6 June 2020 were included. A complicated disease course was defined as hospitalization for COVID-19 requiring noninvasive or invasive ventilation and/or inotropic support, or a fatal outcome | Among patients with CHD, general risk factors (age, obesity and multiple comorbidities) are associated with an increased risk of complicated COVID-19 course. Congenital cardiac defects at particularly high risk were cyanotic lesions, including unrepaired cyanotic defects or Eisenmenger syndrome |
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| Sathananthan et al. | 2019 | Clinical importance of Fontan circuit thrombus in the adult population: significant association with increased risk of cardiovascular events | Retrospective study | The objectives of this study were to determine (1) the incidence of Fontan circuit thrombus and proportion of silent thrombus; (2) any association between Fontan circuit thrombus and markers of Fontan circulatory dysfunction; and (3) the association of Fontan circuit thrombus with adverse cardiac outcomes | The group conducted a retrospective review of adult patients who underwent the Fontan procedure (aged >18 years) followed at St. Paul’s hospital who underwent cardiac computed tomography or magnetic resonance imaging assessment (n = 67). Fontan circulatory dysfunction markers included clinical heart failure, N-terminal probrain natriuretic peptide, ventricular dysfunction, atrioventricular valvular regurgitation, refractory arrhythmias, declining exercise capacity, and hepatic/renal dysfunction. Adverse cardiac outcomes were death, heart transplantation, or surgery for Fontan revision or atrioventricular valve replacement | Given the incidence of Fontan circuit thrombus and association with adverse cardiac outcomes, routine surveillance of the Fontan circuit should strongly be considered. The identification of thrombus should lead to anticoagulation implementation/optimization, along with screening/intervention for reversible Fontan circulatory issues in an attempt to prevent adverse cardiac outcomes |
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| Fusco et al. | 2021 | COVID-19 vaccination in adults with congenital heart disease: real-world data from an Italian tertiary center | Retrospective study | To assess COVID-19 vaccine safety, immunogenicity and acceptance in adults with congenital heart disease | Adults with CHD patients who were offered COVID-19 vaccination from January to June 2021 were included. Data on adverse events, on patients’ attitude towards vaccination and antispike IgG titre were retrospectively collected. A group of healthy individuals with similar age and sex undergoing vaccination was included for comparison | COVID-19 vaccines appear safe in adults with CHD with satisfactory immunogenicity. However, the most vulnerable patients showed lower antibody response. Adults with CHD team may play a key role in vaccine acceptance |
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| Yuan et al. | 2020 | Safety, tolerability, and immunogenicity of COVID-19 vaccines: a systematic review and meta-analysis | Systematic review and meta analysis | The paper aimed to summarize reliable medical evidence by the meta-analysis of all published clinical trials that investigated the safety, tolerability, and immunogenicity of vaccine candidates against COVID-19, caused by SARS-CoV-2 | The PubMed, cochrane library, EMBASE, and medRxiv databases were used to select the studies. 7094 articles were identified initially and 43 were retrieved for more detailed evaluation. 5 randomized, double-blind, placebo-controlled trials were selected. A total of 1604 subjects with either vaccines or placebo infections were included in the meta-analysis within the scope of these articles | Current COVID-19 vaccine candidates are safe, tolerated, and immunogenic, which provides important information for further development, evaluation, and clinical application of COVID-19 vaccine |
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| Sachdeva et al. | 2021 | Effect of acute lower respiratory tract infection on pulmonary artery pressure in children with post-tricuspid left-to-right shunt | Prospective observational study | To examine the influence of clinically severe lower respiratory tract infection on pulmonary artery pressure in children having CHD with post-tricuspid left-to-right shunt, as it may have physiological and clinical implications | 45 children with post-tricuspid left-to-right shunt and clinically severe lower respiratory tract infection were evaluated during the illness and 2 weeks after its resolution. Pulmonary artery systolic pressure was estimated noninvasively using shunt gradient by echocardiography and systolic blood pressure measured noninvasively | In the absence of hypoxia or acidosis, lower respiratory tract infection in patients with post-tricuspid left-to-right shunt causes only a mild increase in the pulmonary artery systolic pressure that is statistically significant, but may not be clinically significant in the majority of patients |
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| Medrano et al. | 2007 | Respiratory infection in congenital cardiac disease. Hospitalizations in young children in Spain during 2004 and 2005: the CIVIC epidemiologic study | Cohort study | To evaluate the rate of hospitalization for acute respiratory tract infection in children less than 24 months with hemodynamically significant congenital cardiac disease, and to describe associated risk factors, preventive measures, etiology, and clinical course | 760 subjects were followed from October 2004 through April 2005 in an epidemiological, multicentric, observational, follow-up, prospective study involving 53 Spanish hospitals | Hospital admissions for respiratory infection in young children with hemodynamically significant congenital cardiac disease are mainly associated with noncardiac conditions, which may be genetic, malnutrition, or respiratory, and to cardiopulmonary bypass. Respiratory syncytial virus was the most commonly identified infectious agent. Incomplete immunoprophylaxis against the virus increased the risk of hospitalization |
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| Sachdeva et al. | 2021 | Outcome of COVID-19-positive children with heart disease and grown-ups with congenital heart disease: a multicentric study from India | Retrospective, multicentric, observational study | To analyze outcome data and identify risk factors associated with mortality in children with heart disease and grown-ups with CHD (GUCH) who had a laboratory-confirmed COVID-19 infection | The study included children with heart disease and GUCH population, who presented with either symptomatic or asymptomatic COVID-19 infection to any of the participating centers. COVID-19-negative patients admitted to these centers constituted the control group | Children with heart disease are at a higher risk of death when they acquire COVID-19 infection. Systematic preventive measures and management strategies are needed for improving the outcomes |
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| Fisher et al. | 2021 | Characteristics and outcomes of acute COVID-19 infection in paediatric and young adult patients with underlying cardiac disease | Retrospective study | To describe outcomes of acute COVID-19 in paediatric and young adult patients with underlying cardiac disease and evaluate the association between cardiac risk factors and hospitalization | A retrospective single-institution review of patients with known cardiac disease and positive severe acute respiratory syndrome coronavirus 2 RT-PCR from 1 March, 2020 to 30 November, 2020. Extracardiac comorbidities and cardiac risk factors were compared between those admitted for COVID-19 illness and the rest of the cohort using univariate analysis | Hospitalizations for COVID-19 were rare among children and young adults with underlying cardiac disease. Extracardiac comorbidities like pulmonary disease were associated with the increased risk of hospitalization while cardiac risk factors were not |
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| Lewis et al. | 2020 | 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 | Retrospective study | To assess the impact and predictors of COVID-19 infection and severity in a cohort of patients with CHD at a large CHD center in New York city | A retrospective review of all individuals with CHD followed at Columbia University Irving Medical Center who were diagnosed with COVID-19 between March 1, 2020 and July 1, 2020. The primary end point was moderate/severe response to COVID-19 infection defined as (1) death during COVID-19 infection; or (2) need for hospitalization and/or respiratory support secondary to COVID-19 infection | The number of symptomatic patients with COVID-19 was relatively low. Patients with CHD with a genetic syndrome and adults at advanced physiological stage were at highest risk for moderate/severe infection |
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| Diaz et al. | 2022 | Describing characteristics of adults with and without congenital heart defects hospitalized with COVID-19 | Retrospective study | To describe patient characteristics in adults with and without congenital heart defects during hospitalization for COVID‐19 | The team analyzed data collected by optum®, a nationally representative database of electronic medical records, for 369 adults with CHDs and 41,578 without CHDs hospitalized for COVID‐19 between January 1, 2020, and December 10, 2020. We used poisson regression to describe and compare epidemiologic characteristics, heart‐related conditions, and severe outcomes between these two groups | Adults with CHD appear to be at greater risk for more severe CHD, including greater risk of ICU admission and longer length of hospital stays |
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| Alizadehsani et al. | 2022 | Factors associated with mortality in hospitalized cardiovascular disease patients infected with COVID-19 | Retrospective observational study | To determine risk factors, symptoms, and comorbidities leading to mortality in CVD patients who are hospitalized with COVID-19 | This study was conducted on 660 hospitalized patients with CVD and COVID-19 recruited between january 2020 and january 2021 in Iran. All patients were diagnosed with the previous history of CVD such as angina, myocardial infarction, heart failure, cardiomyopathy, abnormal heart rhythms, and CHD before they were hospitalized for COVID-19. The team collected data on patient’s signs and symptoms, clinical and paraclinical examinations, and any underlying comorbidities. t-test was used to determine the significant difference between the two deceased and alive groups. In addition, the relation between pairs of symptoms and pairs of comorbidities has been determined via correlation computation | Signs and symptoms such as fever, cough, myalgia, chest pain, chills, abdominal pain, nausea, vomiting, diarrhea, and anorexia had no impact on patients’ mortality. There was a significant correlation between COVID-19 cardiovascular patients’ mortality rate and symptoms such as headache, loss of consciousness, oxygen saturation less than 93%, and need for mechanical ventilation |
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| Sabatino et al. | 2020 | COVID-19 and congenital heart disease: results from a nationwide survey | Multicentric observational nationwide survey | To assess clinical characteristics and outcomes in patients with CHD affected by COVID-19 | A nationwide survey aimed at evaluating consecutive patients with CHD admitted to Italian CHD units affiliated and associated with the CHD working group of the Italian Society of Cardiology, during a six-week period of the initial COVID-19 outbreak in Italy: 21 February–4 April. All patients admitted with CHD, who were diagnosed with COVID-19 and either treated and discharged or who died during hospitalization in the 6-week window, were included independently of their age | Despite previous reports pointing to a higher case-fatality rate among patients with cardiovascular comorbidities, this study observed a mild COVID-19 clinical course in our cohort of CHD patients |
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| Ruperti-Repilado et al. | 2023 | The Coronavirus disease pandemic among adult congenital heart disease patients and the lessons learnt—results of a prospective multicenter European registry | Prospective study | To assess changes in risk stratification and outcomes of adults with CHD patients suffering from COVID-19 between March 2020 and April 2021 | 638 patients (n = 168 during the first wave and n = 470 during the subsequent waves) were included (median age 34 years, 52% women). Main independent predictors for a complicated disease course were male sex, increasing age, a BMI >25 kg/m2, having ≥2 comorbidities, suffering from a cyanotic heart disease or having suffered COVID-19 in the first wave vs. subsequent waves | Apart from cyanotic heart disease, general risk factors for poor outcome in case of COVID-19 reported in the general population are equally important among adults with CHD patients. Risk perception among CHD experts decreased during the course of the pandemic |
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