The surgical management of acute type A aortic dissection: Current options and future trends.

OBJECTIVE: Acute type A aortic dissection (ATAAD) is a catastrophic condition that can be fatal if not treated immediately. We sought to examine the literature and identify evidence behind each method of surgical intervention. METHOD: A comprehensive electronic literature search was done to identify the articles that reported outcomes and discussed surgical techniques in ATAAD. No limits were placed on timing or type of the articles; all results are summarized in a narrative manner within each relevant section. RESULTS: Different units have different approaches for extensive ATAAD; experienced and high-volume units tend to perform aortic root and total-arch replacement, whereas others tend to perform only hemiarch replacement. The evidence shows no significant differences in long-term outcomes. Frozen elephant trunk and endovascular repair play key roles in managing the rest of the aortic dissection that involve the thoracic aorta, and the evidence evolve with their impact on false lumen patency. CONCLUSION: The management of ATAAD is tailored by individual surgeons and unit experience to save lives. Future directions for reducing mortality depend on effective early recognition and accessibility to centralized specialist centers with experience in a wide range of surgical techniques.

The optimal diagnostic methods for COVID-19.

As the world continues to study and understand coronavirus disease (COVID-19), existing investigations and tests have been used to try and detect the virus to slow viral transmission and its global spread. A 'gold-standard' investigation has not yet been identified for detection and monitoring. Initially, computed tomography (CT) was the mainstay investigation as it shows the disease severity and recovery, and its images change at different stages of the disease. However, CT has been found to have limited sensitivity and negative predictive value in the early stages of the disease, and the value of its use has come under debate due to whether its images change the treatment plan, the risk of radiation, as well as its practicality with infection control. Therefore, there has been a shift to the use of other imaging modalities and tests, such as chest X-rays and ultrasound. Furthermore, the use of nucleic acid-based testing such as reverse-transcriptase polymerase chain reaction (RT-PCR) have proven useful with direct confirmation of COVID-19 infection. In this study, we aim to review and analyse current literature to compare RT-PCR, immunological biomarkers, chest radiographs, ultrasound and chest CT scanning as methods of diagnosing COVID-19.