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Hishikawa T, Ohashi T, Kageyama S, Kojima A. Experiences in Emergency Cardiac Surgery of COVID-19-Positive Patients: A Case Series. Cureus 2023; 15:e42799. [PMID: 37664351 PMCID: PMC10470042 DOI: 10.7759/cureus.42799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2023] [Indexed: 09/05/2023] Open
Abstract
The coronavirus disease-2019 (COVID-19) pandemic has placed many restrictions on medical care. The timing of surgical treatment has been particularly affected, with patients experiencing delayed operation dates. This report describes three patients with preoperative COVID-19-positive diagnoses, tested with reverse transcription-polymerase chain reaction, who were urgently treated surgically with excellent results. Case 1 involved an 89-year-old woman with a left ventricular rupture after a myocardial infarction. Case 2 involved a 52-year-old male patient with an acute type A aortic dissection. Case 3 involved a patient with an occlusion of an autologous dialysis shunt. All patient conditions were either life-threatening or overwhelmed hospital beds without surgical treatment. In Japan, we still experience cases where surgery is refused because of COVID-19 positivity, even if emergency surgery is necessary. This report describes three cases where standard precautions were taken, postoperative management was devised, and good results were achieved.
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Affiliation(s)
| | - Takeki Ohashi
- Cardiac Surgery, Nagoya Tokushukai General Hospital, Kasugai, JPN
| | | | - Akinori Kojima
- Cardiac Surgery, Nagoya Tokushukai General Hospital, Kasugai, JPN
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2
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Abraham B, Mathew SD, Sridharan K. A Systematic Review of Arterial Dissections in COVID-19 Patients. Curr Cardiol Rev 2023; 19:e280622206435. [PMID: 35762547 PMCID: PMC10201876 DOI: 10.2174/1573403x18666220628093303] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 03/30/2022] [Accepted: 04/04/2022] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION COVID-19 is often seen presenting with a myriad of signs and symptoms of multiorgan dysfunction including arterial dissection. METHODS Various theories have been proposed such as endothelial dysfunction triggered by hyperinflammatory response that results in rupture of atherosclerotic plaque and subsequent dissection. RESULTS However, the exact incidence is unknown and only case reports and case series have been published till date. CONCLUSION Here we carried out a systematic analysis of published case reports/series related to dissection of the aorta, coronary, cerebral, vertebral, cervical, renal, and splanchnic arteries.
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Affiliation(s)
- Betsy Abraham
- Department of Intensive Care, Salmaniya Medical Complex, Manama, Kingdom of Bahrain
| | | | - Kannan Sridharan
- Department of Pharmacology & Therapeutics, College of Medicine & Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain
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3
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Roberts CS, Roberts WC. Circumferential Fibrosis of the Ascending Aorta After COVID Infection. Am J Cardiol 2022; 184:154-156. [PMID: 36184351 PMCID: PMC9595303 DOI: 10.1016/j.amjcard.2022.07.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 07/06/2022] [Accepted: 07/18/2022] [Indexed: 11/19/2022]
Abstract
After recovering from severe COVID-19 infection, 2 women presented with chest pain. Computed tomographic angiography suggested acute ascending aortic dissection. At operation in both patients, the ascending aorta was encased in dense fibrous tissue, within which were focal collections of mononuclear cells, including many plasma cells. There was no entry tear or dissection. Such findings we have not encountered previously, and PubMed search of “periaortic fibrosis and COVID-19” yielded no similar cases or possible relation.
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4
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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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5
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Mori M, Geirsson A, Vallabhajosyula P, Assi R. Is Intramural Hematoma a Complication of COVID-19 Disease? AORTA : OFFICIAL JOURNAL OF THE AORTIC INSTITUTE AT YALE-NEW HAVEN HOSPITAL 2021; 9:41. [PMID: 34607385 PMCID: PMC8490002 DOI: 10.1055/s-0041-1724006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Makoto Mori
- Division of Cardiac Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Arnar Geirsson
- Division of Cardiac Surgery, Yale University School of Medicine, New Haven, Connecticut
| | | | - Roland Assi
- Division of Cardiac Surgery, Yale University School of Medicine, New Haven, Connecticut
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6
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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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7
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Rosati CM, Nguyen CTN, Fukuhara S. COVID-19 and Aortic Dissections: Collaboration (Among Disciplines and Centers) Is Key. Ann Thorac Surg 2021; 112:683. [PMID: 33434539 PMCID: PMC7797028 DOI: 10.1016/j.athoracsur.2020.12.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 12/18/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Carlo Maria Rosati
- Department of Cardiac Surgery, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48109
| | - Chan Tran N Nguyen
- Department of Cardiac Surgery, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48109
| | - Shinichi Fukuhara
- Department of Cardiac Surgery, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48109.
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8
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Al-Salem SM, El-Eskandarani MS, Constantinou A. Can plastic waste management be a novel solution in combating the novel Coronavirus (COVID-19)? A short research note. WASTE MANAGEMENT & RESEARCH : THE JOURNAL OF THE INTERNATIONAL SOLID WASTES AND PUBLIC CLEANSING ASSOCIATION, ISWA 2021; 39:910-913. [PMID: 33323044 DOI: 10.1177/0734242x20978444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The year 2020 has been noted to be one of major calamity the world over, in which the majority of efforts in research and development have been dedicated towards combating the threat of the novel Coronavirus (COVID-19). Ever since the announcement of COVID-19 as a pandemic, such efforts were dedicated towards the research of its spread and vaccination. Yet still, the world might reach a resolution via an environmental solution that various entities have overlooked, with a plethora of environmental benefits vis-à-vis waste management. In this short communication, the possibility of using plastic solid waste as a substrate to employ copper, and copper alloys and their nanocomposite nanopowders to be used as permanent surface protective coats, is presented. The fact that we present such materials to be of waste origin, is an added value advantage to their beneficial advantage of developing various commodities and products that could be used in our daily lives. Furthermore, the fact that such recyclable materials are susceptible to antiviral properties and chemicals, is an added value that we should not neglect.
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Affiliation(s)
| | | | - Achilleas Constantinou
- London South Bank University, UK
- University College London (UCL), UK
- Department of Chemical Engineering, Cyprus University of Technology, Cyprus
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9
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Terzi F, Fattori R, Di Eusanio M. COVID-19 and Acute Aortic Syndromes: Understanding the Dynamic Interplay. AORTA (STAMFORD, CONN.) 2021; 9:124-125. [PMID: 34624925 PMCID: PMC8598309 DOI: 10.1055/s-0041-1735979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Francesca Terzi
- Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro PU, Italy
| | - Rossella Fattori
- Dipartimento di Cardiochirurgia, Centro di Scienze Cardiovascolari Ospedale Lancisi, Università Politecnica delle Marche, Ancona AN, Italy
| | - Marco Di Eusanio
- Dipartimento di Cardiochirurgia, Centro di Scienze Cardiovascolari Ospedale Lancisi, Università Politecnica delle Marche, Ancona AN, Italy
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10
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Stammers AH, Mongero LB, Tesdahl EA, Patel KP, Jacobs JP, Firstenberg MS, Petersen C, Barletti S, Gibbs A. The assessment of patients undergoing cardiac surgery for Covid-19: Complications occurring during cardiopulmonary bypass. Perfusion 2021; 37:350-358. [PMID: 34041981 PMCID: PMC9069560 DOI: 10.1177/02676591211018983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The outbreak of the novel coronavirus pandemic (COVID-19) has resulted in dramatic changes to the conduct of surgery both from a patient management perspective and in protecting healthcare providers. The current study reports on the status of COVID-19 infections in patients presenting for cardiac surgery with cardiopulmonary bypass (CPB) on circuit complications. A tracking process for monitoring the presence of COVID-19 in adult cardiac surgery patients was integrated into a case documentation system across United States hospitals where out-sourced perfusion services were provided. Assessment included infection status, testing technique employed, surgery status and CPB complications. Records from 5612 adult patients who underwent cardiac surgery between November 1, 2020 and January 18, 2021 from 176 hospitals were reviewed. A sub-cohort of coronary artery bypass graft patients (3283) was compared using a mixed effect binary logistic regression analysis. 4297 patients had negative test results (76.6%) while 49 (0.9%) tested positive for COVID-19, and unknown or no results were reported in 693 (12.4%) and 573 (10.2%) respectively. Coagulation complications were reported at 0.2% in the negative test results group versus 4.1% in the positive test result group (p < 0.001). Oxygenator gas exchange complications were 0.2% in the negative test results group versus 2.0% in the positive test results group (p = 0.088). Coronary artery bypass graft patients with a positive test had significantly higher risk for any CPB complication (p = 0.003) [OR 10.38, CI 2.18–49.53] then negative test patients [OR 0.01, CI 0.00–0.20]. The present study has shown that patients undergoing cardiac surgery with CPB who test positive for COVID-19 have higher CPB complication rate than those who test negative.
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Affiliation(s)
| | | | | | - Kirti P Patel
- Medical Department, SpecialtyCare, Brentwood, TN, USA
| | - Jeffrey P Jacobs
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, FL, USA
| | - Michael S Firstenberg
- Director of Research and Special Projects, William Novick Global Cardiac Alliance, Memphis, TN, USA
| | | | | | - Autumn Gibbs
- Medical Department, SpecialtyCare, Brentwood, TN, USA
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11
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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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12
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Lopez-Marco A, Harky A, Malvindi PG, Verdichizzo D, McPherson I, Roman M, Oo A, Ohri S. Type A aortic syndromes in COVID-19 positive patients: Case series from a UK multicentre study. J Card Surg 2021; 36:2692-2696. [PMID: 33982333 PMCID: PMC8242607 DOI: 10.1111/jocs.15625] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 04/23/2021] [Indexed: 01/16/2023]
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.
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Affiliation(s)
- Ana Lopez-Marco
- Departments of Cardiothoracic Surgery, St Bartholomew's Hospital, London, UK
| | - Amer Harky
- Departments of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Pietro G Malvindi
- Departments of Cardiothoracic Surgery, University Hospital Southampton, Southampton, UK
| | - Danilo Verdichizzo
- Departments of Cardiothoracic Surgery, John Radcliffe Hospital, Oxford, UK
| | - Iain McPherson
- Departments of Cardiothoracic Surgery, Freeman Hospital, Newcastle, UK
| | - Marius Roman
- Departments of Cardiothoracic Surgery, Glenfield Hospital, Leicester, UK
| | - Aung Oo
- Departments of Cardiothoracic Surgery, St Bartholomew's Hospital, London, UK
| | - Sunil Ohri
- Departments of Cardiothoracic Surgery, University Hospital Southampton, Southampton, UK
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13
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McPherson I, Chilvers N, Freystaetter K, Sivaharan A, Kanani M, Williams R, McCaslin J, Nandhra S, Booth K. Dissecting the Management and Outcomes of Thoracic Aortovascular Disease During the COVID-19 Pandemic. Ann Vasc Surg 2021; 75:120-127. [PMID: 33905848 PMCID: PMC8124015 DOI: 10.1016/j.avsg.2021.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/08/2021] [Accepted: 04/13/2021] [Indexed: 11/25/2022]
Abstract
Objective The COVID-19 pandemic has forced the cancellation of planned surgery and led to significant surgical service reductions. Early intervention in aortovascular disease is often critical and cannot be deferred despite these reductions. There is urgent need to evaluate the provision and outcomes of thoracic aortovascular intervention during the peak of the pandemic. Methods Prospective data was collected for patients receiving open and endovascular thoracic aortovascular intervention over two-time points; January-May 2020 and January-May 2019 at three tertiary cardiovascular centres. Baseline demographics, cardiovascular risk and COVID-19 screening results were noted. Primary outcomes were median length of intensive care unit and hospital stay, intra-operative mortality, 30-day mortality, post-operative stroke, and spinal cord injury. Results Patients operated in 2020 (41) had significantly higher median EuroSCORE II than 2019 (53) (7.44 vs. 5.86, P = 0.032) and rates of previous cardiac (19.5% vs. 3.8%, P = 0.019), aortic (14.6% vs. 1.9%, P = 0.041), and endovascular (22.0% vs. 3.8%, P = 0.009) intervention. There was an increase in proportion of urgent cases in 2020 (31.7% vs. 18.9%). There were no intra-operative deaths in 2020 and 1 in 2019 (P = 1.00). There were no significant differences (P ≥ 0.05) in 30-day mortality (4.9% vs. 13.2%), median intensive care unit length of stay (72 vs. 70 hr), median hospital length of stay (8 vs. 9 days), post-operative stroke (3 vs. 6), or spinal cord injury (2 vs. 1) between 2020 and 2019 respectively. Conclusions Despite the increased mortality risk of patients and urgency of cases during COVID-19, complicated by the introduction of cohorting and screening regimens, thoracic aortovascular intervention remained safe with comparable in outcomes to pre-COVID-19.
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Affiliation(s)
- Iain McPherson
- Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom.
| | - Nicholas Chilvers
- Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, United Kingdom
| | - Kathrin Freystaetter
- Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom
| | - Ashwin Sivaharan
- Northern Vascular Centre, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom
| | - Mazyar Kanani
- Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, United Kingdom
| | - Robin Williams
- Northern Vascular Centre, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom
| | - James McCaslin
- Northern Vascular Centre, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom
| | - Sandip Nandhra
- Northern Vascular Centre, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom
| | - Karen Booth
- Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom
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14
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Silvestri V, Recchia GE. Aortic Pathology During COVID - 19 Pandemics. Clinical Reports in Literature and Open Questions on the two Co-Occurring Conditions. Ann Vasc Surg 2021; 75:109-119. [PMID: 33823253 PMCID: PMC8018903 DOI: 10.1016/j.avsg.2021.02.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 12/29/2022]
Abstract
Background Cardiovascular involvement in SARS-CoV-2 infection has emerged as one of viral major clinical features during actual pandemic; limb arterial ischemic events, venous thrombosis, acute myocardial infection and stroke have occurred in patients. Acute aortic conditions have also been described, followed by interesting observations on cases, hypothesis, raised since the emergence of the pandemics. Methods a review of cases in literature of aortic pathology in patients with clinically suspected/microbiologically confirmed COVID-19 infection has been carried out to analyze anagraphic data, clinical presentation, treatment options and outcome. Results Seventeen cases have been included. Mean age of patients was 58.6 ± 15.2 years, with a male to female ratio of 12:15 (70.5% vs. 29.5%). Comorbidities were reported in 11 cases (64.7%), but in 5 cases (29.4%) no previous pathology was signaled in history. Hypertension was the most frequently reported comorbidity, in 8 cases, (47%), followed by renal pathology (17.6%), coronary artery disease (17.6%), previous aortic surgery (11.7%) and arrhythmia (11.7%); but also cerebrovascular disease, diabetes, autoimmune conditions, previous neoplasia and arrhythmia were reported once each. Fever and thoracic pain were the most frequently reported findings at presentation (8 cases, 47% each), followed by respiratory symptoms (6, 35.2%), low lymphocyte count (17.6%), features related to aneurysm rupture, ischemic stroke, abdominal pain and acute renal insufficiency. Reported aortic pathology included: type A aortic dissection (11 cases; 64.7%); new pathology of previous aortic graft (2 cases, 11.7%); 2 aortitis, 1 associated with type A aortic dissection; 1 thoraco-abdominal aortic aneurysm, 1 ruptured aortic aneurysm and 1 aortic embolizing thrombosis. Open surgery was carried out in 10 cases (58.8%), endovascular treatment in 3 (17.6%). Three patients (17.6%) died before surgery. Exitus was reported in 4 cases, with a total mortality of 23.5%. Conclusions Acute aortic events have occurred during pandemic in patients with clinically suspected/microbiologically confirmed COVID-19 infection. Confounding clinical features at presentation, the importance of anamnestic details (as previous vascular graft implant), the observed surgical and postoperatory challenges may suggest the need to consider the implications of the possible link between acute aortic events and SARS-CoV-2 infection, in order to promptly correctly diagnose the patient and respond to specific needs.
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Affiliation(s)
- Valeria Silvestri
- Department of Parasitology, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania.
| | - Gregorio Egidio Recchia
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
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15
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Wang K, Wu C, Xu J, Zhang B, Zhang X, Gao Z, Xia Z. Factors affecting the mortality of patients with COVID-19 undergoing surgery and the safety of medical staff: A systematic review and meta-analysis. EClinicalMedicine 2020; 29:100612. [PMID: 33169112 PMCID: PMC7641595 DOI: 10.1016/j.eclinm.2020.100612] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 10/12/2020] [Accepted: 10/13/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The 2019 novel coronavirus disease (COVID-19) can complicate the perioperative course to increase postoperative mortality in operative patients, and also is a serious threat to medical staff. However, studies summarizing the impact of COVID-19 on the perioperative mortality of patients and on the safety of medical staff are lacking. METHODS We searched PubMed, Cochrane Library, Embase and Chinese database National Knowledge Infrastructure (CNKI) with the search terms "COVID-19″ or "SARS-CoV-2″ and "Surgery" or "Operation" for all published articles on COVID-19 from December 1, 2019 to October 5, 2020. FINDINGS A total of 269 patients from 47 studies were included in our meta-analysis. The mean age of operative patients with COVID-19 was 50.91 years, and 49% were female. A total of 28 patients were deceased, with the overall mortality of 6%. All deceased patients had postoperative complications associated with operation or COVID-19, including respiratory failure, acute respiratory distress syndrome (ARDS), short of breath, dyspnea, fever, cough, fatigue or myalgia, cardiopulmonary system, shock/infection, acute kidney injury and severe lymphopenia. Patients who presented any or more of the symptoms of respiratory failure, ARDS, short of breath and dyspnea after operation were associated with significantly higher mortality (r = 0.891, p < 0.001), while patients whose symptoms were presented as fever, cough, fatigue or myalgia only demonstrated marginally significant association with postoperative mortality (r = 0.675, p = 0.023). Twenty studies reported the information of medical staff infection, and a total of 38 medical staff were infected, and medical staff who used biosafety level 3 (BSL-3) protective equipment did not get infected. INTERPRETATION COVID-19 patients, in particular those with severe respiratory complications, may have high postoperative mortality. Medical staff in close contact with infected patients is suggested to take high level personal protective equipment (PPE). FUNDING Heilongjiang postdoctoral scientific research developmental fund and the National Natural Science Foundation of China.
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Affiliation(s)
- Kun Wang
- Department of Anesthesiology, Harbin Medical University Cancer Hospital, 6 Baojian Road, Nangang District, Harbin 150081, Heilongjiang, China
| | - Changshuai Wu
- Department of Anesthesiology, Harbin Medical University Cancer Hospital, 6 Baojian Road, Nangang District, Harbin 150081, Heilongjiang, China
| | - Jian Xu
- Department of Anesthesiology, Harbin Medical University Cancer Hospital, 6 Baojian Road, Nangang District, Harbin 150081, Heilongjiang, China
| | - Baohui Zhang
- Department of Anesthesiology, Harbin Medical University Cancer Hospital, 6 Baojian Road, Nangang District, Harbin 150081, Heilongjiang, China
| | - Xiaowang Zhang
- Department of Anesthesiology, Harbin Medical University Cancer Hospital, 6 Baojian Road, Nangang District, Harbin 150081, Heilongjiang, China
| | - Zhenglian Gao
- Department of Anesthesiology, Harbin Medical University Cancer Hospital, 6 Baojian Road, Nangang District, Harbin 150081, Heilongjiang, China
| | - Zhengyuan Xia
- Department of Anesthesiology, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, China
- Department of Cerebrovascular Diseases, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Department of Anesthesiology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
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16
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Abate SM, Mantefardo B, Basu B. Postoperative mortality among surgical patients with COVID-19: a systematic review and meta-analysis. Patient Saf Surg 2020; 14:37. [PMID: 33062056 PMCID: PMC7549731 DOI: 10.1186/s13037-020-00262-6] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 09/18/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic puts perioperative providers and staff at risk of viral exposure to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) during aerosol-generating procedures, particularly in asymptomatic carriers.However, the perioperative risk for adverse outcomes in SARS-CoV-2 infected patients remain uncertain and the topic of debate. The current study was designed to determine the postoperative mortality in COVID-19 patients based on a systematic review and meta-analysis of the global published peer-reviewed literature. METHODS A comprehensive search was conducted in PubMed/Medline; Science direct and LILACS from December 29, 2019, to August15, 2020, without language restriction. All observational studies reporting the prevalence of mortality were included while case reports and reviews were excluded. The data from each study were extracted with two independent authors with a customized format excel sheet and the disagreements were resolved by the third author. The methodological quality of included studies was evaluated using a standardized critical appraisal Tool adapted from the Joanna Briggs Institute. RESULTS A total of 715 articles were identified from different databases and 45 articles were selected for evaluation after the successive screening. Twenty-three articles with 2947 participants were included. The meta-analysis revealed a very high global rate of postoperative mortality among COVID-19 patients of 20% (95% CI: 15 to 26) and a postoperative ICU admission rate of 15% (95% confidence interval (CI):10 to 21). CONCLUSION The unexpected high postoperative mortality rate in SARS-CoV-2 infected patients of 20% in the global literature mandates further scrutiny in assuring appropriate surgical indications and perioperative surgical safety measures in this vulnerable cohort of patients. REGISTRATION This systematic review and meta-analysis was registered in Prospero's international prospective register of systematic reviews (CRD42020203362) on August 10, 2020.
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Affiliation(s)
- Semagn Mekonnen Abate
- Department of Anesthesiology, College of Health Sciences and Medicine, Dilla University, PO.BOX:419, Dilla, Ethiopia
| | - Bahiru Mantefardo
- Department of Internal Medicine, College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia
| | - Bivash Basu
- Department of Anesthesiology, College of Health Sciences, University of Calcutta, Kolkata, India
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Mori M, Geirsson A, Vallabhajosyula P, Assi R. Surgical management of thoracic aortic emergency with pre- and postoperative COVID-19 disease. J Card Surg 2020; 35:2832-2834. [PMID: 32667075 PMCID: PMC7405051 DOI: 10.1111/jocs.14865] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The nuance of operative decision making for those in need of emergent operation during coronavirus disease 2019 (COVID‐19) pandemic is increasingly complex in the absence of robust data or guidelines. We present two cases of thoracic aortic emergencies with COVID‐19 disease who survived high‐risk operations to highlight the potential for successful outcomes even in situations compounding patient disease, morbid operation, and the added risk associated with virulent disease in the pandemic time.
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Affiliation(s)
- Makoto Mori
- Division of Cardiac Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Arnar Geirsson
- Division of Cardiac Surgery, Yale University School of Medicine, New Haven, Connecticut
| | | | - Roland Assi
- Division of Cardiac Surgery, Yale University School of Medicine, New Haven, Connecticut
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