Outcomes of acute type A aortic dissection during the COVID‐19 pandemic: An analysis of the Society of Thoracic Surgeons Database

Abstract

Purpose There have been reported reductions of hospital presentation for acute cardiovascular conditions such as myocardial infarction and acute type A aortic dissection (ATAAD) in the United States during the COVID‐19 pandemic. This study examined presentation patterns and outcomes of ATAAD in North America immediately before, and during, the COVID‐19 pandemic. Methods The Society of Thoracic Surgeons Adult Cardiac Surgery Database (STS ACSD) was queried to identify patients presenting with ATAAD in the 12 months pre‐pandemic (March 2019–February 2020), and during the early pandemic (March through June 2020). Demographics and operative characteristics were compared using χ² test and Wilcoxon Rank‐sum test. The median annual case volume designated low‐volume centers versus high‐volume centers (>10 cases per month). Step‐wise variable selection was used to create a risk set used for adjustment of all multivariable models. Results There were 5480 patients identified: 4346 pre‐pandemic and 1134 during pandemic. There was significantly lower volume of median cases per month during the COVID‐19 pandemic period (286 interquartile range [IQR]: 256–306 vs. 372 IQR: 291–433,p = .0152). In historically low‐volume centers (<10 cases per year), there was no difference in volume between the two periods (142 IQR: 133–166 vs. 177 IQR: 139–209, p = NS). In high‐volume centers, there was a decline during the pandemic (140 IQR: 123–148 vs. 212 IQR: 148–224, p = .0052). There was no difference in overall hospital‐to‐hospital transfers during the two time periods (54% of cases pre‐pandemic, 55% during). Patient demographics, operative characteristics, malperfusion rates, and cardiac risk factors were similar between the two time periods. There was no difference in unadjusted operative mortality (19.01% pre‐pandemic vs. 18.83% during, p = .9) nor major morbidity (52.42% pre‐pandemic vs. 51.24% during, p = .5). Risk‐adjusted multivariable models showed no difference in either operative mortality nor major morbidity between time periods. Conclusions For patients presenting to the hospital with ATAAD during the first surge of the pandemic, operative outcomes were similar to pre‐pandemic despite a 30% reduction in volume. Out‐of‐hospital mortality from ATAAD during the pandemic remains unknown. Further understanding these findings will inform management of ATAAD during future pandemics.

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“…COVID-19 has an important impact on the incidence, management and outcome of many cardiovascular diseases ( 18 ), among which AAD is a serious but underestimated problem ( 19 ). During the COVID-19 pandemic, it has been reported that the surgical volume of acute type A aortic dissection has decreased by 30% ( 20 ). A recent study has reported that the COVID-19 has significantly reduced the number of admissions to AAD throughout the year or part of the time, and the in-hospital mortality rate of AAD has increased compared with the pre-pandemic period ( 21 ).…”

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“…In this issue of the Journal of Cardiac Surgery , Arnaoutakis 8 reported the results from a multi‐center retrospective, observational cohort study collated from the STS ACSD. They found the volume of cases of ATAAD was significantly lower during the COVID‐19 pandemic compared to pre‐pandemic.…”

“…Despite no significant differences being found in operative outcomes in ATAAD operations during the pandemic when compared to prepandemic operative outcomes, the large heterogeneous patient demographic—4346 prepandemic and 1134 postpandemic identified in the retrospective cohort study by Arnaoutakis et al enables for a high‐power interpretation. 8 Smaller studies looking at cardiac surgery outcomes show variance in COVID‐19 positive patient outcomes. A study by Saunders et al compared mortality outcomes for patients with ( n = 53) and without COVID‐19( n = 702) undergoing cardiac surgery, from nine UK centers.…”

“…Despite uncontrolled hypertension increasing the risk of TAAD, Arnaoutakis et al found a 30% reduction in patient volume presenting with ATAAD. 8 Therefore, further understanding of out‐of‐hospital mortality from ATAAD during the pandemic is required to quantify the effect of the pandemic on the incidence of ATAAD.…”

“…Using a multivariable linear regression model would enable comparison of the severity of comorbidities in pre‐ and postpandemic patient groups undergoing ATAAD. Despite uncontrolled hypertension increasing the risk of TAAD, Arnaoutakis et al found a 30% reduction in patient volume presenting with ATAAD 8 . Therefore, further understanding of out‐of‐hospital mortality from ATAAD during the pandemic is required to quantify the effect of the pandemic on the incidence of ATAAD.…”