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Journal and News Scan
This joint consensus document aims to facilitate triage and management of patients with aortic dissection, rupture, and malperfusion syndromes during the COVID-19 pandemic. The following issues have been addressed in the care of COVID-19–positive or status unknown patients with aortic emergencies:
1. Management and triage
2. Management of interfacility transfers
3. Preoperative considerations to minimize risk to health care personnel
4. Important anesthetic considerations
5. Precautions to be taken by surgical personnel during the procedure
6. Postoperative considerations
Within the limitations of a meta-analysis, a useful work advancing that PCI may have a hitherto masked or hidden mortality
Depypere et al. report on a survey among members of the European Society of Thoracic Surgeons (ESTS) regarding the impact of coronarvirus disease 2019 on thoracic oncology surgery. They recorded an almost universal impact on surgical practice regardless of the country and the numbers of COVID-19 infected patients. Furthermore, there was no consensus regarding surgical priorities in lung cancer patients, which represents the need of further guideline work within this area.
Kawamura et al. present a retrospective multicenter study of 84 patients who underwent concomitant CABG to aortic surgery and anastomosis of the 109 CABG graft anastomosed either to the native aorta or to the vascular prosthesis. The patency evaluated by CT angiography or coronary angiography was significantly worse for those grafts anastomosed to the vascular graft compared to the native aorta.
In this article, Drs Ceppa et al provide an ad hoc analysis of women in cardiothoracic surgery from the Society of Thoracic Surgeons 2019 workforce report.
In this article in the Journal of Thoracic and Cardiovascular Surgery, Drs Norton et al performed a single institution retrospective analysis of outcomes of 182 patients with acute type B aortic dissection who underwent fenestration/stenting for suspected malperfusion. They demonstrate the laudible outcomes in this patient population, with 0% new onset paraplegia and 7.7% in-hospital mortality in this high-risk patient population, where acute paralysis was a significant risk factor for late mortality. Overall, endovascular fenestration/stenting can be associated with acceptable short- and long-term outcomes.
In this article, Drs Malaisrie and Mehta discuss updates on the indications for TEVAR in type B aortic dissection with comparison of the guidelines from The Society of Thoracic Surgeons, Society of Vascular Surgery, American Heart Association, American College of Cardiology, the European Society of Cardiology, and the Japanese Circulation Society.
Wang et al. present a retrospective single-center study on 712 patients with acute type A dissection who underwent repair utilizing hypothermic circulatory arrest. Within their cohort, preoperative Cystatin-C level and mechanical ventilation times were independent risk factors for acute kidney injury after aortic surgery. Furthermore, acute kidney injury was associated with increased short-term mortality.
Kitamura et al. present a single-center study looking into the outcomes of patients with acute type A intramural hematoma. Within their Japanese collective, patients showing an aortic diameter ≤ 50 mm, no ulcer-like projection, and a pain score of ≤ 3/10 had to be operated on in only 17% of cases, and had a low hospital mortality of 4%. They conclude a watch-and-wait strategy to be reasonable in this very specific patient cohort.
An analysis, from the cardiology viewpoint, of the MI nomenclature issues around the external validity of the EXCEL trial that undermined the EACTS support of the relevant 2018 guidelines