Urgent Cardiac Surgery and COVID-19 Infection: Uncharted Territory: Reply

Abstract

The coronavirus disease 2019 (COVID-19) pandemic has caused a landslide in the organization of all aspects of medical care, including cardiac surgery. Especially for patients needing an urgent lifesaving operation, 2 major aspects should be scrutinized:1.How can COVID-19 infection effectively and quickly be detected in patients needing urgent cardiac surgery?2.What are the possible effects on the postoperative course? The importance of the first question is 2-fold. First, Anticipation of COVID-19–related postoperative complications should lead to quicker detection and treatment. Second, it is crucial to prevent infection of other patients and hospital staff, bearing in mind the recent rise in the infection rate without reliable and safe vaccination up till now. The shared protocol by Hwang and Zhan1Hwang D. Zhan Y. A combination of type A aortic dissection and COVID-19: operative mortality of 33%? (letter).Ann Thorac Surg. 2021; 111: 1734Abstract Full Text Full Text PDF Scopus (6) Google Scholar proposes a combination of risk estimation, blood work, signs of COVID-19 infection on computed tomographic scan, and rapid testing. Risk estimation is not always easy for these patients, especially in case of hemodynamic instability or severe neurologic failure. Computed tomographic scan and blood work, on the other hand, are available in practically all cases and should indeed be reviewed with possible COVID-19 infection in mind. It seems imperative that rapid testing is essential in urgently admitted patients. In our hospital, real-time reverse-transcription polymerase chain reaction testing (Xpert, Xpress SARS CoV-2; Cepheid, Sunnyvale, CA) is performed for all urgent admissions, with results expected within the hour. It is too soon to give reliable data about the effect of COVID-19 infection on the postoperative course in patients operated on for acute type A aortic dissection, because only a few reported cases are available.2Fukuhara S. Rosati C.M. El-Dalati S. Acute type A aortic dissection during the COVID-19 outbreak.Ann Thorac Surg. 2020; 110: e405-e407Abstract Full Text Full Text PDF PubMed Scopus (47) Google Scholar, 3Martens T. Vande Weygaerde Y. Vermassen J. Malfait T. Acute type A aortic dissection complicated by COVID-19 infection.Ann Thorac Surg. 2020; 110: e421-e423Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar, 4Akgul A. Turkyilmaz S. Turkyilmaz G. Toz H. Acute aortic dissection surgery in a patient with COVID-19.Ann Thorac Surg. 2021; 111: e1-e3Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar Extrapolation of observed effects in patients with severe COVID-19 infection is applied to cardiac surgery patients, addressing mainly the observation of hypercoagulability and hyperinflammation.5Gunaydin S. Stammers A.H. Perioperative management of COVID-19 patients undergoing cardiac surgery with cardiopulmonary bypass.Perfusion. 2020; 35: 465-473Crossref PubMed Scopus (7) Google Scholar Therefore, reporting experience remains crucial, and participation in a multicentric registry6COVIDSurg CollaborativeMortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study.Lancet. 2020; 396: 27-38Abstract Full Text Full Text PDF PubMed Scopus (974) Google Scholar should be greatly encouraged. A Combination of Type A Aortic Dissection and COVID-19: Operative Mortality of 33%?The Annals of Thoracic SurgeryVol. 111Issue 5PreviewWe read with great interest the collection of case reports on type A aortic dissection (TAAD) in patients with confirmed or suspected coronavirus disease 2019 (COVID-19) infection.1-3 Two patients tested positive for COVID-19 postoperatively, and the third patient was diagnosed based on computed tomographic scan findings. Because these patients were not tested for COVID-19 at presentation, it is unclear whether precautions were taken perioperatively. Full-Text PDF