key: cord-1040628-5s0fmawp
authors: Chu, Michael W.A.; Ouzounian, Maral; El-Hamamsy, Ismail; Peterson, Mark D.
title: Commentary: COVID-19 and acute aortic dissection: So many questions, so few answers
date: 2020-10-29
journal: JTCVS Tech
DOI: 10.1016/j.xjtc.2020.10.039
sha: cd0f592dd1e88ac44c2885c2073a865f58739a34
doc_id: 1040628
cord_uid: 5s0fmawp

nan

Central Message: COVID-19 has complicated patient care in acute aortic dissection, requiring a thoughtful team approach that is individualized for each patient.

The COVID-19 pandemic has challenged our ability to deliver safe, timely, and high-quality care for our patients with acute aortic dissection, while protecting our highly specialized aortic team members. The pandemic has impacted the clinical, educational and administrative activities of cardiac surgery units globally. Furthermore, our ability to effectively treat patients has been severely affected. This has translated into a dramatic reduction in elective aneurysm repairs, increased wait times with consequent potential harm to patients. The pandemic has also affected urgent surgical care: we suspect that patients have avoided seeking hospital care due to fear of acquiring COVID-19, resulting in reduced demand for emergent dissection repair. This is corroborated by an increase in the number of patients dying out of hospital, and an overall excess mortality seen in several jurisdictions during the pandemic not directly attributable to COVID-19 infections 1 .

Pacini and colleagues from Bologna have shared with us their heroic experiences in managing patients with acute aortic dissection early in the first wave of the pandemic through a national lock-down 2 . They reported patient avoidance behaviors causing delays in diagnosis, late presentations with malperfusion, and several patients who died before undergoing definitive J o u r n a l P r e -p r o o f repair. They were fortunate to have rapid testing protocols to confirm COVID negative status on all operative patients who ultimately had very good outcomes with surgical repair. Although the authors observed pulmonary infiltrates on the preoperative CT that were concerning for COVID-19 in 30% of their patients, none of them tested positive for COVID-19.

Patients with acute aortic dissection will remain a challenging group to treat during this everlasting pandemic. Timely access to emergency surgical care remains a life-saving priority; however, several considerations need to be made. 2) When taking a COVID positive or suspect patient to the operating room for acute type A aortic dissection repair, operative expedience is likely paramount. Strategies to simplify surgical repair and minimize circulatory arrest and myocardial ischemic times should be considered. In this scenario, the primary focus must be on perioperative survival, even at the cost of late re-operation. Patients with acute aortic dissection remain challenging at the best of times. COVID-19 has complicated patient care significantly, requiring a very careful and thoughtful team approach that is individualized for each patient, considering local pandemic activity and resources. These patients deserve our very best efforts, while balancing the needs of the pandemic as a whole.

The COVID-19 Pandemic and Acute Aortic Dissections in New York: A Matter of Public Health

The effect of COVID-19 lockdown on acute type A aortic dissection: insights from Bologna

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study