ABSTRACT
OBJECTIVES: We seek to report our management protocol and early outcomes of acute type A aortic dissection (ATAAD) repair during the early phase of coronavirus disease 2019 (COVID-19). METHODS: From January 23 to April 30, 2020, we performed ATAAD repair for 33 patients, including three with pregnancy-related TAADs. Confirmation of COVID-19 depended on the results of two nucleic acid tests and pulmonary computed tomography scan. Based on testing results and hemodynamic stability, patients were triaged to an isolated intensive care unit or negative pressure operating room for emergency surgery. RESULTS: Mean age 50.2 ± 13.3 years and 20 were male (60.1%) and 8 patients were febrile (>37.3°C; 24.2%) and 17 were lymphopenic (51.5%). No patient was excluded from COVID-19 infection preoperatively. Extensive aortic repair with total arch replacement (TAR) was performed in 24 (72.7%), and limited proximal repair in 9 patients (27.3%). Cardiopulmonary bypass and cross-clamp times averaged 177 ± 34 and 88 ± 20 min for TAR, and 150 ± 30 and 83 ± 18 min for hemiarch, respectively. The mean operation time was 410 ± 68.3 min. Operative mortality was 6.1% (2/33). Complications included reintubation in four (12.1%), acute kidney failure in two (6.1%), and cerebral infarction in one (3.0%). No paraplegia nor re-exploration for bleeding occurred. COVID-19 was excluded in 100% eventually. No nosocomial infection occurred. Nor did any patient/surgical staff develop fever or test positive during the study period. CONCLUSIONS: The results of this study show that our management protocol based on testing results and hemodynamic stability in patients with ATAAD during the COVID-19 pandemic was effective and achieved favorable early surgical outcomes.
Subject(s)
Aortic Aneurysm, Thoracic , Aortic Dissection , Blood Vessel Prosthesis Implantation , COVID-19 , Acute Disease , Adult , Aortic Dissection/epidemiology , Aortic Dissection/surgery , Aortic Aneurysm, Thoracic/diagnosis , Aortic Aneurysm, Thoracic/epidemiology , Aortic Aneurysm, Thoracic/surgery , Female , Humans , Male , Middle Aged , Pandemics , Retrospective Studies , SARS-CoV-2 , Time Factors , Treatment OutcomeABSTRACT
The nuance of operative decision making for those in need of emergent operation during coronavirus disease 2019 (COVID-19) pandemic is increasingly complex in the absence of robust data or guidelines. We present two cases of thoracic aortic emergencies with COVID-19 disease who survived high-risk operations to highlight the potential for successful outcomes even in situations compounding patient disease, morbid operation, and the added risk associated with virulent disease in the pandemic time.
Subject(s)
Aorta, Thoracic/surgery , Aortic Aneurysm, Thoracic/surgery , Aortic Dissection/surgery , Betacoronavirus , Coronavirus Infections/epidemiology , Emergencies , Pneumonia, Viral/epidemiology , Vascular Surgical Procedures/methods , Aged, 80 and over , Aortic Dissection/diagnosis , Aortic Dissection/epidemiology , Aortic Aneurysm, Thoracic/diagnosis , Aortic Aneurysm, Thoracic/epidemiology , COVID-19 , Comorbidity , Female , Humans , Male , Middle Aged , Pandemics , Postoperative Period , Preoperative Period , SARS-CoV-2 , Tomography, X-Ray ComputedABSTRACT
Acute aortic dissection is one of the most common life-threatening diseases that affects the aortic vessel. We present a case of acute Stanford type A aortic dissection in a patient with coronavirus disease 2019 (COVID-19) under treatment with angiotensin-converting enzyme inhibitors. A 68-year-old woman complaining of acute chest pain and dyspnea was admitted to the emergency clinic of our hospital on May 6, 2020. She had history of diabetes and hypertension. This is one of the first acute aortic surgery cases among patients with COVID-19.
Subject(s)
Aortic Aneurysm, Thoracic/surgery , Aortic Aneurysm, Thoracic/virology , Aortic Dissection/surgery , Aortic Dissection/virology , COVID-19/complications , SARS-CoV-2 , Aged , Aortic Dissection/diagnosis , Aortic Aneurysm, Thoracic/diagnosis , COVID-19/diagnosis , COVID-19/therapy , Female , HumansABSTRACT
As of April 7, 2020, approximately 1,300,000 cases and 80,000 deaths related to coronavirus disease 2019 (COVID-19) have been reported in more than 180 countries/territories. Health care infrastructures and resources, particularly as it relates to the care of the most critically ill patients, are currently being strained globally. In this context, however, there has been little clinical guidance or information regarding life-threatening conditions requiring emergency operation that cannot be delayed. We present a case of acute type A aortic dissection in a patient with COVID-19 to highlight the clinical implications of a true emergent procedure during the COVID-19 outbreak.