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Butt S, Ghimire B, Harky A. Understanding outcomes of emergency aortic dissection repair during COVID-19 pandemic: What lessons have we learnt? J Card Surg 2022; 37:4552-4554. [PMID: 36326105 PMCID: PMC9877845 DOI: 10.1111/jocs.17088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 10/20/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Sundas Butt
- Department of Trauma and Orthopedic SurgeryQueen's Medical CentreNottinghamUK
| | - Bishop Ghimire
- Department of GastroenterologyRussells Hall HospitalDudleyUK
| | - Amer Harky
- Department of Cardiothoracic SurgeryLiverpool Heart and Chest HospitalLiverpoolUK
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Arnaoutakis GJ, Wallen TJ, Desai N, Martin TD, Thourani VH, Badhwar V, Wegerman ZK, Young R, Grau-Sepulveda M, Zwischenberger B, Beaver TM, Jacobs JP, Sultan I. Outcomes of acute type A aortic dissection during the COVID-19 pandemic: An analysis of the Society of Thoracic Surgeons Database. J Card Surg 2022; 37:4545-4551. [PMID: 36378930 DOI: 10.1111/jocs.17085] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 09/21/2022] [Accepted: 09/23/2022] [Indexed: 11/16/2022]
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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Affiliation(s)
- George J Arnaoutakis
- Division of Cardiovascular Surgery, University of Florida Health, Gainesville, Florida, USA
| | - Tyler J Wallen
- Department of Surgery, Geisinger Health System, Wilkes Barre, Pennsylvania, USA
| | - Nimesh Desai
- Division of Cardiac Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Tomas D Martin
- Division of Cardiovascular Surgery, University of Florida Health, Gainesville, Florida, USA
| | - Vinod H Thourani
- Department of Surgery, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Vinay Badhwar
- Department of Cardiovascular & Thoracic Surgery, West Virginia University, Charlestown, West Virginia, USA
| | - Zachary K Wegerman
- Department of Cardiothoracic Surgery, Outcomes Research and Assessment Group, Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Rebecca Young
- Department of Cardiothoracic Surgery, Outcomes Research and Assessment Group, Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Maria Grau-Sepulveda
- Department of Cardiothoracic Surgery, Outcomes Research and Assessment Group, Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Brittany Zwischenberger
- Department of Cardiothoracic Surgery, Outcomes Research and Assessment Group, Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Thomas M Beaver
- Division of Cardiovascular Surgery, University of Florida Health, Gainesville, Florida, USA
| | - Jeffrey P Jacobs
- Division of Cardiovascular Surgery, University of Florida Health, Gainesville, Florida, USA
| | - Ibrahim Sultan
- Division of Cardiovascular Surgery, University of Florida Health, Gainesville, Florida, USA
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Bissacco D, Franchin M, Piffaretti G, Luzzani L, D'Oria M, Casana R, Domanin M, Bellosta R, Trimarchi S. Impact of COVID-19 on aortic operations. Semin Vasc Surg 2021; 34:37-42. [PMID: 34144746 PMCID: PMC8133823 DOI: 10.1053/j.semvascsurg.2021.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/27/2021] [Accepted: 04/30/2021] [Indexed: 01/20/2023]
Abstract
The coronavirus disease 2019 (COVID-19) outbreak has profoundly affected all aspects of medicine and surgery. Vascular surgery practice and interventions were also forced to change in order to deal with new COVID-19–related priorities and emergencies. In this setting, difficulties in aortic disease management were two-fold: new vascular complications related to COVID-19 infection and the need to guarantee prompt and correct treatment for the general “non-COVID-19” population. Furthermore, discomfort deriving from precautions to minimize the risk of virus transmission among patients and among health care professionals, the need to separate COVID-19–positive from COVID-19–negative patients, and the high incidence of postoperative complications in COVID-19 cases created a challenging scenario for cardiac operations. The aim of this review was to provide evidence derived from the published literature (case reports, case series, multicenter experience, and expert opinion) on the impact of the COVID-19 outbreak on aortic vascular surgery services and interventions, describing COVID-19–related findings, intraoperative and postoperative outcomes, as well as the impact of the COVID-19 outbreak on noninfectious aortic patients.
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Affiliation(s)
- Daniele Bissacco
- Vascular Surgery Unit, Istituto di Ricovero e Cura a Carattere Scientifico Ca Granda Ospedale Maggiore Policlinico, Via Sforza 35, 20122, Milan, Italy.
| | - Marco Franchin
- Department of Medicine and Surgery, University of Insubria School of Medicine, Varese, Italy
| | - Gabriele Piffaretti
- Department of Medicine and Surgery, University of Insubria School of Medicine, Varese, Italy; Vascular Surgery Unit, Azienda Socio Sanitaria Territoriale Settelaghi, Varese, Italy
| | - Luca Luzzani
- Vascular Surgery Unit, Poliambulanza Foundation, Brescia, Italy
| | - Mario D'Oria
- Vascular Surgery Unit, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Renato Casana
- Vascular Surgery Unit, Istituto di Ricovero e Cura a Carattere Scientifico Auxologico, Milan, Italy
| | - Maurizio Domanin
- Vascular Surgery Unit, Istituto di Ricovero e Cura a Carattere Scientifico Ca Granda Ospedale Maggiore Policlinico, Via Sforza 35, 20122, Milan, Italy; Department of Clinical and Community Sciences, University of Milan, Milan, Italy
| | | | - Santi Trimarchi
- Vascular Surgery Unit, Istituto di Ricovero e Cura a Carattere Scientifico Ca Granda Ospedale Maggiore Policlinico, Via Sforza 35, 20122, Milan, Italy; Department of Clinical and Community Sciences, University of Milan, Milan, Italy
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Commentary: Whether it's the best of times or the worst of times, it's the only time we've got. ACTA ACUST UNITED AC 2020; 5:26-27. [PMID: 34173550 PMCID: PMC7836618 DOI: 10.1016/j.xjon.2020.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 12/12/2020] [Accepted: 12/15/2020] [Indexed: 11/22/2022]
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