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Acute type A aortic dissection patients undergoing surgical repair during the COVID-19 pandemic

Yun-Tai Yao¹, Chun-Mei Xie², Hong-Bai Wang¹

¹Anesthesia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China.

|April 28, 2025

Insights

Surgical outcomes for acute type A aortic dissection (ATAAD) patients were similar before and during the COVID-19 pandemic. However, ATAAD patients with COVID-19 faced significantly higher mortality and morbidity risks following emergency surgery.

Area of Science:

Cardiovascular Surgery
Infectious Diseases
Public Health

Background:

Acute type A aortic dissection (ATAAD) is a life-threatening condition requiring immediate surgical intervention.
The COVID-19 pandemic has profoundly impacted global surgical practices.
The effect of the pandemic on ATAAD surgical repair outcomes was previously unclear.

Purpose of the Study:

To systematically review and compare surgical outcomes for ATAAD patients before and during the COVID-19 pandemic.
To analyze the outcomes of ATAAD patients who underwent surgery concurrently with COVID-19 infection.

Main Methods:

A systematic review and meta-analysis of studies comparing ATAAD surgery outcomes.
Literature review of published cases involving ATAAD patients with COVID-19.
Searched major databases including PubMed, CNKI, VIP, WANFANG, and SinoMed up to January 2024.
Utilized RevMan for meta-analysis, estimating pooled odds ratios and weighted mean differences.

Main Results:

Patients undergoing surgery during the pandemic were older, had lower BMI, and higher smoking rates.
Overall mortality and morbidity rates were comparable between pre-pandemic and pandemic groups, with increased pneumonia incidence during the pandemic.
Of 24 COVID-19 positive ATAAD patients, 83.3% recovered, but 4 died from complications like multi-organ and respiratory failure.

Conclusions:

Hospitalized outcomes for ATAAD surgery remained largely comparable between pre-pandemic and pandemic periods.
Concomitant COVID-19 infection in ATAAD patients undergoing emergent surgery significantly elevated risks of mortality and morbidity.
Findings highlight the importance of considering COVID-19 status in surgical planning for ATAAD.

Read full analysis

Abstract

Background:

Acute type A aortic dissection (ATAAD) is a deadly form of acute aortic syndrome which necessitates emergency surgical repair. Coronavirus disease-19 (COVID-19) pandemic has caused a significant impact on surgery globally. The influence of the COVID-19 pandemic on ATAAD patients undergoing surgical repair remains undetermined.

Methods:

We conducted a systematic review and meta-analysis of studies comparing ATAAD patients undergoing aortic surgery before versus during the COVID-19 pandemic and literature review of published cases reporting COVID-19 patients undergoing surgical repair for ATAAD. PubMed, China National Knowledge Infrastructure, VIP, WANFANG, and SinoMed databases were searched for relevant studies and case reports till January 21st, 2023, and the database search was updated on January 3rd, 2024. Meta-analysis was performed by utilizing RevMan. Pooled odds ratio (OR) and 95% confidence interval (CI) were estimated for dichotomous data, and weighted mean difference (WMD) and 95% CI for continuous data, respectively. All P-values were 2-sided and statistical significance was defined as P < .05.

Results:

Meta-analysis of 5 included studies comparing ATAAD patients undergoing aortic surgery before versus during the COVID-19 pandemic demonstrated that, the patients in Group During-Pandemic (DP) were older than those in Group Before-Pandemic (BP; P = .005), and the body mass index of the patients in Group DP was lower than that of the patients in Group BP (P = .002), more patients in Group DP were smokers (P = .02). Meta-analysis also showed that, either the composite incidence of mortality and morbidities or individual morbidity was comparable between 2 groups, except that more patients in Group DP developed pneumonia (P = .05). Literature reviews of 24 published cases reporting COVID-19 patients undergoing surgical repair for ATAAD demonstrated that, twenty (83.3%) patients recovered well after aortic surgery and were finally discharged from hospital. Unfortunately, 4 patients died postoperatively, 3 due to multiple organ failure and one due to respiratory failure (RF). Reported postoperative complications included hypoxia, endotracheal re-intubation, RF, renal failure, coagulopathy, fever, multi-organ failure and shock.

Conclusion:

The hospitalized outcomes of ATAAD patients undergoing surgical repair before versus during the COVID-19 were mostly comparable. ATAAD patients with concomitant COVID-19 infection who underwent emergent surgical repair had a high risk of mortality and morbidities.

Keywords:

COVID-19 acute type A aortic dissection aortic surgery outcomes

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