key: cord-0047590-zchpya6j
authors: Assi, Roland; Geirsson, Arnar; Vallabhajosyula, Prashanth
title: Commentary: Managing Thoracic Aortic Emergencies During A Pandemic
date: 2020-07-14
journal: J Thorac Cardiovasc Surg
DOI: 10.1016/j.jtcvs.2020.07.026
sha: 5b2d84be8edb3e4b58b8a131246e82e752d5e30a
doc_id: 47590
cord_uid: zchpya6j

nan

The COVID-19 pandemic continues to burden the healthcare infrastructure with unprecedented 10 challenges. Management of acute aortic emergencies during a pandemic increases the complexity 11 of an already resource-heavy disease.

In this issue of The Journal, Mehta et al. propose an algorithmic approach to the triage and 13 management of thoracic aortic emergencies during the COVID-19 pandemic. 1 We find the 14 algorithm very useful, with a well pondered balance between optimal patient care and healthcare 15 personnel safety.

In general, we are following PPE and viral testing guidelines as suggested by the authors, 17 particularly during airway manipulation. We diverge slightly in some aspects of the 18 management. When indicated, we continue to offer patients emergent operations with no delays, 19 usually before the COVID-19 tests have resulted. We are eagerly awaiting the arrival of a rapid, 20 sensitive and reliable test, to avoid the additional technicalities of performing these complex 21 surgeries under COVID-19 restrictions for patients whose tests are negative. We have access to a specifically redesigned negative pressure operating room with ante and post chambers. Any 23 prosthesis or device that could potentially be needed (aortic grafts, stent-grafts, valve prosthesis, 24 etc.) is relocated within reach to avoid excessive in and out of room traffic. We determine the 25 extent of the aortic reconstruction as per our usual practice, regardless of COVID-19 status. We 26 continue to rely on intraoperative TEE routinely, which we find extremely valuable in the 27 management of these patients. Our anesthesiologists are using a designated probe, probe sleeve Figure) . This patient underwent a valve-sparing aortic root 36 replacement and a hemiarch replacement and was discharged home within a week. All other 37 patients underwent expeditious surgeries and recovered fully.

The authors' algorithm provides a practical and safe framework for cardiovascular surgeons to 39 navigate the pitfalls of performing complex cardiovascular surgeries during a pandemic with a 40 highly contagious and relatively lethal virus. We would add that surgeons should engage their 41 hospital systems and contribute to a reliable and sustainable redesign of the perioperative space 42 and workflow. In our opinion, this redesign is essential to balance the challenges imposed by a 43 viral pandemic with the continued delivery of optimal patient care. 

Triage and Management of Aortic Emergencies during the 48

COVID-19 Pandemic: A Consensus Document Supported by AATS and ASCVTS