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Management of acute type A aortic dissection during COVID-19 outbreak: Experience from Anzhen
Chen-Han Zhang1, Wei-Guo Ma1, Yong-Liang Zhong1
1Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Aortic Disease Center, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China.
Insights
This study reports a successful management protocol for acute type A aortic dissection (ATAAD) during the COVID-19 pandemic. The protocol ensured favorable surgical outcomes with low mortality and complication rates.
Area of Science:
- Cardiovascular Surgery
- Infectious Disease Epidemiology
- Critical Care Medicine
Background:
- The early phase of the COVID-19 pandemic presented unique challenges for managing acute surgical emergencies.
- Acute type A aortic dissection (ATAAD) requires urgent surgical intervention, complicated by potential COVID-19 transmission risks.
Purpose of the Study:
- To outline a management protocol for ATAAD repair during the COVID-19 pandemic.
- To report early surgical outcomes of ATAAD patients managed under this protocol.
Main Methods:
- A cohort of 33 patients underwent ATAAD repair between January and April 2020.
- Patient management involved COVID-19 testing (nucleic acid tests, CT scans) and hemodynamic stability assessment for triage to appropriate isolation facilities.
- Surgical procedures included extensive aortic repair with total arch replacement (TAR) or limited proximal repair.
Main Results:
- Operative mortality was 6.1% (2/33), with low rates of complications such as reintubation (12.1%), acute kidney failure (6.1%), and cerebral infarction (3.0%).
- No paraplegia or re-exploration for bleeding occurred.
- COVID-19 was definitively excluded in all patients, and no nosocomial infections were observed in patients or staff.
Conclusions:
- The developed management protocol effectively balanced urgent ATAAD treatment with infection control measures.
- The protocol facilitated favorable early surgical outcomes, demonstrating safety and efficacy during the COVID-19 pandemic.
Objectives:
We seek to report our management protocol and early outcomes of acute type A aortic dissection (ATAAD) repair during the early phase of coronavirus disease 2019 (COVID-19).
Methods:
From January 23 to April 30, 2020, we performed ATAAD repair for 33 patients, including three with pregnancy-related TAADs. Confirmation of COVID-19 depended on the results of two nucleic acid tests and pulmonary computed tomography scan. Based on testing results and hemodynamic stability, patients were triaged to an isolated intensive care unit or negative pressure operating room for emergency surgery.
Results:
Mean age 50.2 ± 13.3 years and 20 were male (60.1%) and 8 patients were febrile (>37.3°C; 24.2%) and 17 were lymphopenic (51.5%). No patient was excluded from COVID-19 infection preoperatively. Extensive aortic repair with total arch replacement (TAR) was performed in 24 (72.7%), and limited proximal repair in 9 patients (27.3%). Cardiopulmonary bypass and cross-clamp times averaged 177 ± 34 and 88 ± 20 min for TAR, and 150 ± 30 and 83 ± 18 min for hemiarch, respectively. The mean operation time was 410 ± 68.3 min. Operative mortality was 6.1% (2/33). Complications included reintubation in four (12.1%), acute kidney failure in two (6.1%), and cerebral infarction in one (3.0%). No paraplegia nor re-exploration for bleeding occurred. COVID-19 was excluded in 100% eventually. No nosocomial infection occurred. Nor did any patient/surgical staff develop fever or test positive during the study period.
Conclusions:
The results of this study show that our management protocol based on testing results and hemodynamic stability in patients with ATAAD during the COVID-19 pandemic was effective and achieved favorable early surgical outcomes.