Management of acute aortic services during the COVID-19 pandemic: a retrospective cohort study from the Middle East

Yosef Manla; Gopal Bhatnagar; Naureen Khan; Firas Al Badarin; Yazan AlJabery; Vivek Kakar; Tareq Aleinati; Yusuf Bayrak; Wael AlMahmeed; Stefan Sänger; Ahmed Bafadel; Laszlo Göbölös

doi:10.1097/MS9.0000000000000813

Management of acute aortic services during the COVID-19 pandemic: a retrospective cohort study from the Middle East

Ann Med Surg (Lond). 2023 Jun 5;85(7):3279-3283. doi: 10.1097/MS9.0000000000000813. eCollection 2023 Jul.

Authors

Affiliations

¹ Departments ofCardiac Surgery.
² Cardiology, Heart, Vascular, and Thoracic Institute, Cleveland Clinic Abu Dhabi.
³ Critical Care Institute, Cleveland Clinic Abu Dhabi, UAE.

Abstract

COVID-19 created a challenging situation for cardiac surgery and associated acute care programs around the world. While non-urgent cases might be postponed, operating on life-threatening conditions, including type A aortic dissection (TAAD), must be sustained despite the ongoing pandemic. Therefore, the authors investigated the impact of the COVID-19 pandemic on their urgent aortic program.

Methods: The authors included consecutive patients presenting with TAAD (n=36) in the years 2019 and 2020 [pre-pandemic period (2019; n=16) and the pandemic era (2020; n=20)] at a tertiary care centre. Patient characteristics, TAAD presenting symptoms, operative techniques, postoperative outcomes, and length of stay were determined retrospectively using chart review and were compared between both years.

Results: An increase occurred in the absolute number of TAAD referrals during the pandemic era. Patients were featured by younger age of presentation (pre-pandemic group: 47.6±18.7, and the pandemic group: 50.6±16.2 years, P=0.6) in contrast to Western data but showed similar male predominance (4:1) in both groups. There was no statistical difference in baseline comorbidities between the groups. Length of hospital stay [20 (10.8-56) vs. 14.5 (8.5-53.3) days, P=0.5] and intensive care unit stay [5 (2.3-14.5) vs. 5 (3.3-9.3) days, P=0.4] were comparable between both groups. Low rates of postoperative complications were registered in both groups with no significant between-group difference. There was no significant difference in the rates of in-hospital mortality between both groups [12.5% (2) vs. 10% (2), P=0.93].

Conclusions: Compared with the pre-pandemic era (2019), there was no difference in resource utilisation and clinical outcomes of patients presenting with TAAD during the first year of COVID-19 pandemic (2020). Structural departmental re-configuration and optimal personal protective equipment utilisation warrant maintained satisfactory outcomes in critical healthcare scenarios. Future studies are required to further investigate aortic care delivery during such challenging pandemics.

Keywords: SARS-CoV-2; TAAD; critical care; outcomes; surgical performance.