Early outcomes of Stanford type A aortic dissection under the coronavirus disease 2019 (COVID-19) pandemic: a multicentre study from Hubei province
Early outcomes of Stanford type A aortic dissection under the coronavirus disease 2019 (COVID-19) pandemic: a multicentre study from Hubei province
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2019 年冠状病毒病 (COVID-19) 大流行背景下斯坦福 A 型主动脉夹层的早期结果：湖北省的一项多中心研究
DOI：
10.1093/icvts/ivaa209
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发表时间：
2020-12-01
影响因子：
--
通讯作者：
Wu, Long
中科院分区：
文献类型：
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作者：
Hu, Xingjian;Wang, Yin;Wu, Long
摘要 目的 我们的目标是比较 2019 年冠状病毒病 (COVID-19) 大流行期间斯坦福 A 型主动脉夹层 (TAAD) 的短期结果与正常时期的结果，并总结我们在 COVID-19 背景下对 TAAD 患者的围手术期管理经验。方法 2020年1月17日至2020年3月8日，湖北省8家心血管外科中心共收治27例TAAD患者（COVID-19组）。去年同期同中心91例TAAD患者数据来源于湖北省心脏外科挂号系统（对照组）。确定了 26 对 (1:2) 的倾向评分匹配亚组。评估围手术期数据和短期结果。结果 COVID-19 组中有 9 名患者被归类为疑似疾病（9/27，33.3%），其他患者被排除（18/27，66.7%）。术前没有人经过实验室确诊。 COVID-19组的平均等待时间、交叉钳夹时间和停循环时间较长（22.9 ± 8.3 vs 9.7 ± 4.0小时，P < 0.001；135 ± 36 vs 103 ± 45分钟，P = 0.003；分别为 24±9 分钟 vs 17±8 分钟，P<0.001）。两组的 30 天或院内死亡率均为 3.8%（P = 1.0）。 COVID-19组与较长的通气时间和重症监护病房时间相关（分别为81±71天与45±19小时，P<0.001；7.4±3.8天与4.5±2.7天；P<0.001）。两组脑卒中、神经功能缺损、急性肾损伤、肺部感染及再次手术等并发症发生率无统计学差异。对这些患者的血清抗体检测显示，9 名疑似病例中有 7 名免疫球蛋白 G 呈阳性。其他患者及相关医护人员未发生交叉感染。结论 通过充分的准备和适当的保护，在 COVID-19 大流行期间对 TAAD 患者进行紧急手术后可以获得满意的早期结果。
Abstract OBJECTIVES Our goal was to compare the short-term outcomes of Stanford type A aortic dissection (TAAD), during the coronavirus disease 2019 (COVID-19) pandemic with those during normal times and summarize our perioperative management experience of patients with TAAD in the context of COVID-19. METHODS From 17 January 2020 to 8 March 2020, a total of 27 patients with TAAD were operated on in 8 cardiovascular surgery centres in Hubei Province (COVID-19 group). The data from 91 patients with TAAD from the same centres during the same period last year were extracted from the Hubei Cardiac Surgery Registration System (control group). A propensity score matched subgroup of 26 pairs (1:2) was identified. Perioperative data and short-term outcomes were assessed. RESULTS Nine patients in the COVID-19 group were categorized as suspicious for the disease (9/27, 33.3%), and others were excluded (18/27, 66.7%). No one was laboratory confirmed preoperatively. The average waiting, cross-clamp and circulatory arrest times were longer in the COVID-19 group (22.9 ± 8.3 vs 9.7 ± 4.0 h, P < 0.001; 135 ± 36 vs 103 ± 45 min, P = 0.003; 24 ± 9 vs 17 ± 8 min, P < 0.001, respectively). The 30-day or in-hospital deaths were 3.8% in both groups (P = 1.0). The COVID-19 group was associated with longer ventilation and intensive care unit times (81 ± 71 vs 45 ± 19 h, P < 0.001; 7.4 ± 3.8 vs 4.5 ± 2.7 days; P < 0.001, respectively). There were no statistical differences between the 2 groups in the incidence of complications such as stroke, neurological deficit, acute kidney injury, pulmonary infection and reoperation. Serum antibody tests for those patients showed 7 out of 9 suspected cases were Immunoglobulin G positive. No cross-infection occurred in other patients or associated medical staff. CONCLUSIONS With adequate preparation and appropriate protection, satisfactory early outcomes can be achieved after emergency operations for patients with TAAD during the COVID-19 pandemic.