Emergency surgical analysis of 29 patients with type A aortic dissection during COVID-19 epidemic / 中华胸心血管外科杂志

ABSTRACT

Objective:To summarize the experience of emergency treatment of type A aortic dissection during the prevalence of COVID-19.Methods:Retrospectively analyzed the data of 29 patients undergoing emergency surgery for type A aortic dissection during the outbreak of corona virus disease-19 ( COVID-19) in Wuhan Asian Heart Hospital from January 23 to March 31, including 25 males and 4 females aged 34-72 years with mean age (49.17±9.63) years.There were 10 cases in Wuhan and 19 cases outside the city.All patients were diagnosed and indicated for emergency surgery through online consultation before transportation.After the primary exclusion of COVID-19 by pulmonary CT scanning in the emergency department, the patients were admitted to the isolation ward. Emergency surgery was performed after emergency nucleic acid testing and preoperative examing. Postoperatives were carried to a single room in the ICU for isolation until COVID-19 was excluded, nucleic acid testing and reexamination of pulmonary CT were performed if they were fever during hospitalization.All medical personnel involved in the operation and perioperative management took three levels of protection and medical observation.Results:There were 5 cases of type A1 in the aortic root, 2 cases of type A2, 22 cases of type A3, 2 cases of simple arch, 27 cases of complex type (Sun's classification).12 cases of Bentall, 2 cases of Wheats, 15 cases of ascending aorta replacement, 14 cases of aortic valve repair, 25 cases of aortic arch replacement, 23 cases of trunk stents, 2 cases of hybridization, 6 cases of concurrent coronary artery bypass grafting, and 2 cases of tricuspid valvuloplasty.In the whole group, 1 case of COVID-19 was confirmed and 1 was suspected.The time of cardiopulmonary bypass was(224.00±21.14)min, the blocking time was(146.17±18.75)min, the postoperative ventilator assisted(65.07±10.36)h, the hospitalization time was(27.03±5.64)days, there were no hospitalized deaths, 4 cases of postoperative liver function damage, 6 cases of acute renal function damage, and 7 of pulmonary infection.None of the medical staff involved in the operation and perioperative management were infected with COVID-19.Conclusion:During the period of major infectious diseases, the admission and treatment procedures of critical and severe patients should be standardized, and the control of nosocomial infection should be strengthened. Emergency surgery is an effective means to rescue type A active vein interlayer, and the safety of protecting medical staff is guaranteed.