Type A Aortic Dissection during COVID-19 Pandemic: Report from Tertiary Aortic Centers in the United States and China.

Coronavirus disease 2019 (COVID-19) has substantially disrupted many processes of care related to emergency cardiac conditions, while there has been no clinical guidance regarding the management of type A aortic dissection. A retrospective multicenter study involving 52 consecutive patients (mean age 52.3, 28.9% women) with type A aortic dissection during COVID-19 pandemic was conducted at tertiary aortic centers in Michigan, Wuhan and Changsha (China). Twenty-four (46.2%) were considered clinically suspicious for COVID-19 based on radiographic lung lesions (70.8%) followed by dyspnea (25.0%), cough (12.5%) and fever (12.5%). Overall, 47 (90.4%) underwent an operation and 5 (9.6%) managed non-operatively. All suspected patients underwent a reverse-transcriptase-polymerase-chain-reaction (RT-PCR) at arrival, whereas 82.1% in the non-suspected (p=0.054). Among the 24 patients either non-operatively managed or whose operation was delayed for >24 hours, only one (4.2%) died. A total of 3 (6.4%) operated patients had a positive RT-PCR at various timings, including one non-suspected patient preoperatively and two with very recent COVID-19 infection. The first patient died of respiratory failure despite uneventful surgical repair and maximal medical management. The postoperative course of both patients with recent COVID-19 was characterized by severe coagulopathy requiring massive transfusions and prolonged ICU stay. However, both survived to hospital discharge. In light of the possible dismal outcomes associated with dual diagnoses of type A aortic dissection/COVID-19 and the higher-than-expected number of asymptomatic carriers, all type A dissection patients should be immediately tested for COVID-19. Surgical interventions in patients recovered from recent COVID-19 may be safe.