key: cord-275531-88iqxzqc
authors: Yu, Xinyu; Feng, Xin; Wei, Xiang
title: Management of acute aortic dissection during the COVID-19 pandemic: Experience from an epicenter in Wuhan, China
date: 2020-05-10
journal: J Vasc Surg
DOI: 10.1016/j.jvs.2020.04.478
sha: 
doc_id: 275531
cord_uid: 88iqxzqc

nan

The COVID-19 global pandemic has affected more than 1 million individuals across 200 countries or regions. 1 The disease hit Wuhan, a megacity in China, in December 2019. During the subsequent 3 months, more than 50,000 cases of COVID-19 had emerged in Wuhan alone, which had a substantial effect on the clinical management of some life-threatening emergencies, such as acute aortic dissection, because of the following challenges.

First, it was estimated that w81% of confirmed cases of COVID-19 were asymptomatic, at least initially, and might not even need hospitalization. 2 In addition, the basic reproductive number of COVID-19 was w2.2, indicating a highly infectious disease. 3 Hence, patients with acute aortic dissection could potentially be carriers of SARS-Cov-2 (the pathogen of COVID-19) and might cause a spread of nosocomial infections in hospitals. Second, the prioritized task for controlling the outbreak of COVID-19 had inevitably required most of the local medical resources. Thus, the remaining medical resources for treating other diseases (including acute aortic dissection) were rather limited in the particular circumstances in Wuhan during the pandemic period. Finally, the community lockdown during the COVID-19 outbreak had, as expected, led to a delay in the transfer of patients to hospitals.

Coping with these challenges, our team successfully performed surgery to treat four patients with acute Stanford type A aortic dissection during the COVID-19 pandemic. In addition, neither the patients nor the healthcare providers contracted COVID-19 infection during the perioperative periods owing to the following strategies:

1. Efficient emergency networks were well preserved, ensuring a timely diagnosis and treatment for patients with acute aortic dissection. 2. With a high index of suspicions, we tried our best to avoid cross infections and nosocomial infections during the patients' entire hospital course, starting from their admission in the emergency room. 3. Personal protective equipment was mandatory for every member of the team and at a serious response level for all emergency operations. 4. Face masks were also provided to all patients and were compulsory throughout their hospital stay; more importantly, sufficient education in preventing virus transmission was constantly provided to the patients and their relatives. 5. As long as the patient's vital signs were stable, preoperative screening of COVID-19 was enforced; thus, every patient was assessed for potential COVID-19 infection using both serum antibody testing and computed tomography examination. Some typical pulmonary computed tomography features must be carefully ruled out, such as bilateral groundglass opacity and subsegmental consolidation. 4 6. Whenever possible, the patients were kept in isolation rooms postoperatively.

Worldwide experience in managing life-threatening surgical emergencies (eg, type A aortic dissection) under the extremely stressful condition during the COVID-19 pandemic is limited. We hope our lessons learned from this small series of four patients can help surgeons to manage the challenges caused by the epidemic. 

Coronavirus disease 2019 (COVID-19) and cardiovascular disease

Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention

Early transmission dynamics in Wuhan, China, of novel coronaviruseinfected pneumonia

Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China