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Type A Aortic Dissection During COVID-19 Pandemic: Report From Tertiary Aortic Centers in the United States and China.
Fukuhara, Shinichi; Tang, Hao; Kim, Karen M; Tan, Ling; Shen, Kangjun; Song, Guobao; Tang, Tao; Patel, Himanshu J; Wei, Xiang; Yang, Bo.
  • Fukuhara S; Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan.
  • Tang H; Department of Cardiovascular Surgery, the Second Xiangya Hospital of Central South University, Changsha, China. Electronic address: dr.tanghao@csu.edu.cn.
  • Kim KM; Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan.
  • Tan L; Department of Cardiovascular Surgery, the Second Xiangya Hospital of Central South University, Changsha, China.
  • Shen K; Department of Cardiovascular Surgery, the Second Xiangya Hospital of Central South University, Changsha, China.
  • Song G; Department of Cardiovascular Surgery, the Second Xiangya Hospital of Central South University, Changsha, China.
  • Tang T; Department of Cardiovascular Surgery, the Second Xiangya Hospital of Central South University, Changsha, China.
  • Patel HJ; Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan.
  • Wei X; Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. Electronic address: xiangwei@tjh.tjmu.edu.cn.
  • Yang B; Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan. Electronic address: boya@med.umich.edu.
Semin Thorac Cardiovasc Surg ; 33(2): 303-312, 2021.
Article in English | MEDLINE | ID: covidwho-912925
ABSTRACT
Coronavirus disease 2019 (COVID-19) has substantially disrupted many processes of care related to emergency cardiac conditions, while there has been no clinical guidance regarding the management of type A aortic dissection. A retrospective multicenter study involving 52 consecutive patients (mean age 52.3, 28.9% women) with type A aortic dissection during COVID-19 pandemic was conducted at tertiary aortic centers in Michigan, Wuhan and Changsha (China). Twenty-four (46.2%) were considered clinically suspicious for COVID-19 based on radiographic lung lesions (70.8%) followed by dyspnea (25.0%), cough (12.5%), and fever (12.5%). Overall, 47 (90.4%) underwent an operation and 5 (9.6%) managed nonoperatively. All suspected patients underwent a reverse-transcriptase-polymerase-chain-reaction at arrival, whereas 82.1% in the nonsuspected (P = 0.054). Among the 24 patients either nonoperatively managed or whose operation was delayed for >24 hours, only 1 (4.2%) died. A total of 3 (6.4%) operated patients had a positive reverse-transcriptase-polymerase-chain-reaction at various timings, including 1 nonsuspected patient preoperatively and 2 with very recent COVID-19 infection. The first patient died of respiratory failure despite uneventful surgical repair and maximal medical management. The postoperative course of both patients with recent COVID-19 was characterized by severe coagulopathy requiring massive transfusions and prolonged ICU stay. However, both survived to hospital discharge. In light of the possible dismal outcomes associated with dual diagnoses of type A aortic dissection/COVID-19 and the higher-than-expected number of asymptomatic carriers, all type A dissection patients should be immediately tested for COVID-19. Surgical interventions in patients recovered from recent COVID-19 may be safe.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 / Aortic Dissection Type of study: Experimental Studies / Observational study / Prognostic study Limits: Female / Humans / Male / Middle aged Country/Region as subject: North America / Asia Language: English Journal: Semin Thorac Cardiovasc Surg Journal subject: Vascular Diseases / Cardiology Year: 2021 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 / Aortic Dissection Type of study: Experimental Studies / Observational study / Prognostic study Limits: Female / Humans / Male / Middle aged Country/Region as subject: North America / Asia Language: English Journal: Semin Thorac Cardiovasc Surg Journal subject: Vascular Diseases / Cardiology Year: 2021 Document Type: Article