Type A aortic syndromes in COVID‐19 positive patients: Case series from a UK multicentre study

Abstract

Objective The coronavirus disease (COVID‐19) increases the respiratory complications and carries a higher mortality in the immediate postoperative period. The aim of this study was to analyze the outcomes of patients with type A acute aortic syndromes (AAS) diagnosed with COVID‐19 in the perioperative period. Methods Retrospective analysis of prospectively collected data between March and August 2020 from 20 participating cardiac surgery centers in the United Kingdom. Results Among 122 patients who underwent emergency surgical repair for type A AAS at the participating centers, 3 patients (2.5%) tested positive for COVID‐19 in the preoperative screeing, and 4 cases turned to be positive in the postoperative period having been operated on an unknown COVID‐19 status. Another patient was diagnosed of COVID‐19 disease based on radiological features. These eight patients had increased postoperative complications, including respiratory failure, longer ventilation times, and Intensive Therapy Unit (ITU) stay and increased mortality when compared with COVID‐19 negative patients. Conclusion COVID‐19 disease in the perioperative period of type A AAS poses a challenge. Despite the increasing morbidity and mortality associated with the virus, the prognosis of the aortic disease is poorer and emergency surgery should not be contraindicated based on the COVID‐19 diagnosis alone.

Cardiac surgery on patients with COVID‐19: a systematic review and meta‐analysis

“…From these, 100 had the wrong population group or intervention, 105 reported the wrong outcomes, 56 were non‐observational studies and 29 in which the data were not extractable. Accordingly, a total of 18 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 articles fit the inclusion criteria and were included in our systematic review and meta‐analysis. This is outlined in Fig.…”

Fatal association of COVID‐19 and acute type A aortic dissection

“…It has been suggested that complications and mortality of cardiovascular emergencies and number of severe cases had been increased during the COVID‐19 pandemic 7,8 . Moreover, in another study, postoperative mortality was higher in COVID‐19 patients who needed cardiovascular surgery, compared to the patients without COVID‐19 9 . Type A aortic dissection in COVID‐19 patients seems to associate with increased severity that even with immediate and proper diagnosis, it has higher mortality.…”

“… 7 , 8 Moreover, in another study, postoperative mortality was higher in COVID‐19 patients who needed cardiovascular surgery, compared to the patients without COVID‐19. 9 Type A aortic dissection in COVID‐19 patients seems to associate with increased severity that even with immediate and proper diagnosis, it has higher mortality.…”

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

“…In the early phase of the pandemic during spring 2020, there were anecdotal observations of fewer patients presenting with acute aortic emergencies such as acute type A aortic dissection (ATAAD), though safe surgical repair has been described 2 . These observations were followed by numerous published studies revealing fewer emergency department presentations for acute myocardial infarction as well as greater rates of out‐of‐hospital cardiac arrest 3–10 . Additionally, in myocardial infarction patients specifically, there have been delayed presentations, slower rates to reperfusion, increasing frequency of post‐infarction mechanical complications, as well as greater rates of out‐of‐hospital death attributable to ischemic heart disease 7–11 .…”