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Bima P, Giamello JD, Rubiolo P, Risi F, Balzaretti P, Lauria G, Vallino D, Lupia E, Morello F. Clinical Presentation and Emergency Department Management Checkpoints of Acute Aortic Syndromes during the First Two Waves of the COVID-19 Pandemic. J Clin Med 2023; 12:6601. [PMID: 37892739 PMCID: PMC10607079 DOI: 10.3390/jcm12206601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/13/2023] [Accepted: 10/14/2023] [Indexed: 10/29/2023] Open
Abstract
The COVID-19 pandemic has deeply affected the activity and patient flows of Emergency Departments (EDs), and concern for the worsening outcome of cardiovascular emergencies has been raised. However, the impact of COVID-19 on all subtypes of acute aortic syndromes (AASs) has not been evaluated so far. Cases of AASs managed in the ED of three hub hospitals in a large area of Northern Italy were retrospectively analyzed, comparing those registered during the pandemic (March 2020 to May 2021) with corresponding pre-COVID-19 periods. A total of 124 patients with AAS were managed during the COVID-19 period vs. 118 pre-COVID-19 (p = 0.70), despite a -34.6% change in ED visits. Posterior chest pain at presentation was the only clinical variable with a different prevalence (46.0% vs. 32.2%, p = 0.03). Surgery and endovascular treatment rates were unchanged. Time intervals influenced by patient transfer to the hub center were longer during the COVID-19 period and longest during high viral circulation periods. Ninety-day mortality was unchanged, with a higher mortality trend during the pandemic surges. In conclusion, ED presentation and care of AASs were marginally affected by COVID-19, but efforts are needed to preserve efficient patient transfer to specialized centers and prevent mortality, especially during pandemic peaks.
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Affiliation(s)
- Paolo Bima
- S.C. Medicina d’Urgenza U (MECAU), Ospedale Molinette, A.O.U. Città della Salute e della Scienza, 10126 Torino, Italy; (P.B.); (E.L.)
- Dipartimento di Scienze Mediche, Università degli Studi di Torino, 10126 Torino, Italy; (J.D.G.)
- Cardiovascular Research Institute Basel (CRIB), 4056 Basel, Switzerland
| | - Jacopo Davide Giamello
- Dipartimento di Scienze Mediche, Università degli Studi di Torino, 10126 Torino, Italy; (J.D.G.)
- Medicina d’Urgenza, Ospedale S. Croce e Carle, 12100 Cuneo, Italy
| | - Paolo Rubiolo
- Dipartimento di Scienze Mediche, Università degli Studi di Torino, 10126 Torino, Italy; (J.D.G.)
| | - Francesca Risi
- Dipartimento di Emergenza e Accettazione, Ospedale Mauriziano, 10128 Torino, Italy
| | - Paolo Balzaretti
- Dipartimento di Emergenza e Accettazione, Ospedale Mauriziano, 10128 Torino, Italy
| | - Giuseppe Lauria
- Medicina d’Urgenza, Ospedale S. Croce e Carle, 12100 Cuneo, Italy
| | - Domenico Vallino
- Dipartimento di Emergenza e Accettazione, Ospedale Mauriziano, 10128 Torino, Italy
| | - Enrico Lupia
- S.C. Medicina d’Urgenza U (MECAU), Ospedale Molinette, A.O.U. Città della Salute e della Scienza, 10126 Torino, Italy; (P.B.); (E.L.)
- Dipartimento di Scienze Mediche, Università degli Studi di Torino, 10126 Torino, Italy; (J.D.G.)
| | - Fulvio Morello
- S.C. Medicina d’Urgenza U (MECAU), Ospedale Molinette, A.O.U. Città della Salute e della Scienza, 10126 Torino, Italy; (P.B.); (E.L.)
- Dipartimento di Scienze Mediche, Università degli Studi di Torino, 10126 Torino, Italy; (J.D.G.)
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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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Ramandi A, Akbarzadeh MA, Khaheshi I, Khalilian MR. Aortic dissection and Covid-19; a comprehensive systematic review. Curr Probl Cardiol 2022; 48:101129. [PMID: 35139402 PMCID: PMC8817949 DOI: 10.1016/j.cpcardiol.2022.101129] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 01/25/2022] [Indexed: 12/19/2022]
Abstract
Coronavirus disease 19 (Covid-19) has been declared as a pandemic disease since March 2020; causing wide array of signs and symptoms, many of which result in increased mortality rates worldwide. Although it was initially known as an acute respiratory disease, Covid-19 is accompanied with several extrapulmonary manifestations, of which the cardiovascular ones are of major importance. Among other cardiovascular complications of Covid-19, aortic dissection has been a significant yet underrated problem. The pathophysiology of aortic dissection consists of various inflammatory pathways, that could be influenced by Covid-19 infection. We herein have reviewed articles inclusive of aortic dissection concurrent with Covid-19 infection in a systematic manner, along with the probable similarities in pathophysiology of aortic dissection with Covid-19 infection.
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Affiliation(s)
- Alireza Ramandi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.; Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Akbarzadeh
- Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Isa Khaheshi
- Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Mohammad Reza Khalilian
- Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Bissacco D, Lomazzi C, Buongiovanni G, Magni A, Domanin M, Casana R, Bismuth J, van Herwaarden JA, Upchurch GR, Trimarchi S. COVID-19 and aortic disease: a practical systematic review of the literature on management and outcomes. THE JOURNAL OF CARDIOVASCULAR SURGERY 2021; 62:527-534. [PMID: 34581554 DOI: 10.23736/s0021-9509.21.12049-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Since the advent of the 2019 coronavirus (COVID-19) outbreak, vascular specialists have faced dramatic changes in clinical and surgical practice. Although COVID-19 pulmonary signs and symptoms were the most pertinent problems initially, in the long term cardiovascular complications became the most fearsome, with poor outcomes in terms of morbidity and mortality. Algorithms and decision-making procedures have been modified, not only to treat new clinical findings in COVID-19 positive patients, but also to avoid complications related to pulmonary and systemic infections. Additionally, COVID-19 negative patients experienced challenging management, due to hospital crowding, the risk of nosocomial COVID-19 transmission, and pandemic emergencies. In this context, aortic interventions were subject to several difficulties. First, in COVID-19 positive patients, there was the onset of new pathological scenarios including thrombotic manifestations and the subsequent complications. Second, in both COVID-19 negative and positive patients, there was a need to deliver optimal treatment with acceptable perioperative risks, forcing a rethinking of decisionmaking especially in terms of indications for treatments. The aim of this systematic review is to present evidence published on COVID-19 and aortic-related issues, highlighting some challenging aspects regarding management, treatment and outcomes.
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Affiliation(s)
- Daniele Bissacco
- Vascular Surgery Unit, IRCCS Ca Granda Ospedale Maggiore Policlinico, Milan, Italy -
| | - Chiara Lomazzi
- Vascular Surgery Unit, IRCCS Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Agnese Magni
- Vascular Surgery Unit, IRCCS Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maurizio Domanin
- Vascular Surgery Unit, IRCCS Ca Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical and Community Sciences, University of Milan, Milan, Italy
| | - Renato Casana
- Vascular Surgery Unit, IRCCS Auxologico, Milan, Italy
| | - Jean Bismuth
- Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | | | - Gilbert R Upchurch
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - Santi Trimarchi
- Vascular Surgery Unit, IRCCS Ca Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical and Community Sciences, University of Milan, Milan, Italy
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Lopez‐Marco A, Harky A, Verdichizzo D, Hope E, Rosser B, McPherson I, Kelly R, Holland L, Ye Oo A. Early experience of aortic surgery during the COVID-19 pandemic in the UK: A multicentre study. J Card Surg 2021; 36:848-856. [PMID: 33442890 PMCID: PMC8013563 DOI: 10.1111/jocs.15307] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 12/24/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND A significant restructuring of the healthcare services has taken place since the declaration of the coronavirus disease 2019 (COVID-19) pandemic, with elective surgery put on hold to concentrate intensive care resources to treat COVID-19 as well as to protect patients who are waiting for relatively low risk surgery from exposure to potentially infected hospital environment. METHODS Multicentre study, with 19 participating centers, to define the impact of the pandemic on the provision of aortovascular services and patients' outcomes after having adapted the thresholds for intervention to guarantee access to treatment for emergency and urgent conditions. Retrospective analysis of prospectively collected data, including all patients with aortovascular conditions admitted for surgical or conservative treatment from the 1st March to the 20th May 2020. RESULTS A total of 189 patients were analyzed, and 182 underwent surgery. Diagnosis included: aneurysm (45%), acute aortic syndrome (44%), pseudoaneurysm (4%), aortic valve endocarditis (4%), and other (3%). Timing for surgery was: emergency (40%), urgent (34%), or elective (26%). In-hospital mortality was 12%. Thirteen patients were diagnosed with COVID-19 during the peri-operative period, and this subgroup was not associated with a higher mortality. CONCLUSIONS There was a significant change in service provision for aortovascular patients in the UK. Although the emergency and urgent surgical activity were maintained, elective treatment was minimal during early months of the pandemic. The preoperative COVID-19 screening protocol, combined with self-isolation and shielding, contributed to the low incidence of COVID-19 in our series and a mortality similar to that of pre-pandemic outcomes.
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Affiliation(s)
- Ana Lopez‐Marco
- Department of Cardiothoracic SurgeryBarts Heart Centre, St. Bartholomew's HospitalLondonUK
| | - Amer Harky
- Department of Cardiothoracic SurgeryLiverpool Heart and Chest HospitalLiverpoolUK,Department of Integrative Biology, Faculty of Health and Life ScienceUniversity of LiverpoolLiverpoolUK,Liverpool Centre for Cardiovascular ScienceUniversity of Liverpool and Liverpool Heart and Chest HospitalLiverpoolUK,Department of Congenital Cardiac SurgeryAlder Hey Children HospitalLiverpoolUK
| | | | - Emma Hope
- Department of Cardiothoracic SurgeryUniversity Hospital of SouthamptonSouthamptonUK
| | - Barbara Rosser
- Department of Cardiothoracic SurgeryRoyal Brompton and Harefield NHS TrustLondonUK
| | - Iain McPherson
- Department of Cardiothoracic SurgeryFreeman HospitalNewcastleUK
| | - Ronan Kelly
- Department of Cardiothoracic SurgeryRoyal Victoria HospitalBelfastUK
| | - Luke Holland
- Department of Cardiothoracic SurgeryRoyal Sussex County HospitalBrightonUK
| | - Aung Ye Oo
- Department of Cardiothoracic SurgeryBarts Heart Centre, St. Bartholomew's HospitalLondonUK
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Roman M, Harky A, Brazier A, Lim K, Gradinariu G, Oo A, Mariscalco G, Lopez-Marco A. Turn down of acute aortic syndrome cases during COVID-19: Results from UK multicentre studies. J Card Surg 2020; 36:199-202. [PMID: 33169430 PMCID: PMC7839712 DOI: 10.1111/jocs.15187] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 10/10/2020] [Accepted: 10/13/2020] [Indexed: 01/16/2023]
Abstract
Objective The coronavirus disease 2019 (COVID‐19) pandemic has restructured the healthcare systems, prioritizing resources to treat COVID‐19 patients. The aim of this study was to establish if patients affected by acute aortic syndrome (AAS) had unrestricted access to emergency treatment and evaluate outcome of these patients during the peak of the pandemic. Methods This is a retrospective analysis of prospectively collected data between March and June 2020 from 19 participating cardiac surgery centers in the United Kingdom. Results Among 95 patients who presented with an AAS in the participating centers; 85 (89%) underwent surgery, 7 (7%) were turned down for surgery because of their profile of comorbidities, and 3 (3%) died on transfer. Among the patients treated conservatively, three of them (43%) were alive at 30 days. We observed no significant restriction in access to treatment for AAS during the early months of the pandemic. Conclusion Services for life‐threatening aortic surgery patients were maintained during the COVID‐19 period through patient selection and timing of surgery. The rate of surgical turn‐down was comparable to published figures despite the challenges faced during the COVID‐19 pandemic.
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Affiliation(s)
- Marius Roman
- Department of Cardiothoracic Surgery, Glenfield Hospital, Leicester, UK
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK.,Department of Integrative Biology, Faculty of Life Sciences, University of Liverpool, Liverpool, UK.,Liverpool Heart and Chest Hospital, Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK
| | - Andrew Brazier
- Department of Cardiothoracic Surgery, University Hospital Coventry, Coventry, UK
| | - Kelvin Lim
- Department of Cardiothoracic Surgery, The Royal Infirmary of Edinburgh, Edinburgh, UK
| | - George Gradinariu
- Department of Cardiothoracic Surgery, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Aung Oo
- Department of Cardiothoracic Surgery, St Bartholomew's Hospital, London, UK
| | | | - Ana Lopez-Marco
- Department of Cardiothoracic Surgery, St Bartholomew's Hospital, London, UK
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