key: cord-0713125-g05uyeh0
authors: Lopez-Marco, Ana; Rosser, Barbara; Harky, Amer; Verdichizzo, Danilo; McPherson, Iain; Hope, Emma; Qadri, Syed; Oo, Aung; Tsang, Geoffrey; Cale, Alex; Mascaro, Jorge; Field, Mark; Kuduvalli, Manoj; Mariscalco, Giovanni; Anderson, Jon; Bhudia, Sunil; Rosendahl, Ulrich; Hyde, Jonathan; Krasopoulos, George; Forlani, Stefano; Booth, Karen; Dandekar, Uday; Lim, Kelvin; Jeganathan, Reuben; Bittar, Nidal; Kanani, Mazyar; El-Shafei, Hussein; Balacumaraswani, L.
title: The fate of patients with acute aortic syndrome during Covid-19 Pandemic: a UK multicentre study
date: 2020-11-26
journal: JTCVS Open
DOI: 10.1016/j.xjon.2020.11.008
sha: 8515ef2f97512a0dff8d9f00d302ec7da29c5247
doc_id: 713125
cord_uid: g05uyeh0

OBJECTIVE The COVID-19 Pandemic posed challenges to healthcare services across the world. There has been a significant restructuring of healthcare resources to protect services for patients with COVID-related illness and to maintain emergency and urgent medical and surgical activity. This study assess access to emergency treatment, logistical challenges and outcomes of patients with acute aortic syndrome during early months of COVID-19 Pandemic in the United Kingdom. METHODS A multicentre study participated by 19 cardiac centres from 1st March to 20th May 2020. A retrospective analysis of prospectively collected data obtained from individual centres’ national cardiac surgical database. Demographic details, choice of treatment, operative details and outcomes were collected. COVID screening, timing of surgery and outcomes of COVID positive and negative patients were also analysed. RESULTS 88 patients presented with acute aortic syndrome to participating centres from 1st March to 20th May 2020. There were 79 aortic dissections (89.8%), 7 intramural haematomas (7.9%) and 2 penetrating aortic ulcers (2.3%). Seventy-nine patients (89.8%) underwent surgery. In-hospital mortality was 25.3% (n= 20). Postoperative complications included: 13.9% postoperative stroke – 11.4% permanent and 2.3% temporary, 16.5% rate of haemofiltration and 10.1% rate of tracheostomy. 9 patients were treated conservatively with mortality of 60%. 7 patients were diagnosed with COVID and there was no associated mortality. CONCLUSION Despite of extensive restructuring of healthcare resources, access to emergency and urgent treatment for acute aortic syndrome patients was maintained in the early months of COVID-19 Pandemic in the UK. Clinical outcomes were similar to pre-pandemic period.

treatments. [1] [2] [3] [4] In United Kingdom (UK), like the rest of the world, all elective cardiac and aortovascular 156 surgery were put on hold in order to protect patients access to emergency and urgent surgery. 157

Patients with acute aortic syndrome, having a devastating natural history with incremental 158 hourly risk of mortality, require emergency surgery. [5] 159

In this study, we assess the incidence, access to emergency treatment, logistical issues as well 160 A total of 9 patients were not managed surgically due to a variety of reasons. 281

Three patients were accepted for emergency surgery but died either waiting for transfer or en 282 route to the specialised centre or during the anaesthetic induction due to aortic rupture and 283 cardiac tamponade. Mean age was 63.3 years (range 45 -81 years) 284

Five patients were denied emergency surgery due to clinical complexity. Three of them had 285 history of previous cardiac or aortic surgery and one of them had signs of COVID-19 on the 286 preoperative CT scan. Mean EuroScore II was 16.9%. Two patients were discharged alive, 287 hence the mortality for this group was 60%. not require surgical treatment. He was diagnosed of COVID-19 during the hospital admission 290 but did not develop any symptoms or respiratory complications and was discharged home. 291

Regional and temporal variation in presentation of acute aortic syndromes 293

There was a clear regional variation in the presentation of the AAS (Table 3) partipating aortic centres to assess access to emergency treatment for AAS patients during the 460 early months of the COVID-19 pandemic in the UK. A total of 88 patients were analysed and 461 90% of them underwent surgery, with similar outcomes to pre-pandemic times. Despute the 462 COVID-19 screening was not awaited before emergency surgery was offered, only 7 patients 463 of COVID-19 cases started to increase exponentially and the AAS activity decreased initially 472 due to the reduced presentation to emergency departments. Both curves reached a peak 473 around mid of April to descend in a parallel way after that. Note that he scale for the COVID-474 19 mortality has been adapted and has to be multiplied x100. 

COVID-19: Guidance for Triage of Non-Emergence Surgical Procedures

College of Surgeons. www.facs.org. Published online 17 th

Cardiac Surgery and the COVID-19 Outbreak: what does it mean? 488 www.pcronline.com