Your browser doesn't support javascript.
COVID-19 and aortic disease: a practical systematic review of the literature on management and outcomes.
Bissacco, Daniele; Lomazzi, Chiara; Buongiovanni, Gianluca; Magni, Agnese; Domanin, Maurizio; Casana, Renato; Bismuth, Jean; VAN Herwaarden, Joost A; Upchurch Jr, Gilbert R; Trimarchi, Santi.
  • Bissacco D; Unit of Vascular Surgery, IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy - danielebissaccomd@gmail.com.
  • Lomazzi C; Unit of Vascular Surgery, IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
  • Buongiovanni G; Unit of Vascular Surgery, IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
  • Magni A; Unit of Vascular Surgery, IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
  • Domanin M; Unit of Vascular Surgery, IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
  • Casana R; Department of Clinical and Community Sciences, University of Milan, Milan, Italy.
  • Bismuth J; Unit of Vascular Surgery, IRCCS Italian Institute for Auxology, Milan, Italy.
  • VAN Herwaarden JA; Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX, USA.
  • Upchurch Jr GR; Department of Vascular Surgery, University Medical Center, Utrecht, the Netherlands.
  • Trimarchi S; Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA.
J Cardiovasc Surg (Torino) ; 62(6): 527-534, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1441430
ABSTRACT

INTRODUCTION:

Since the outbreak of the 2019 coronavirus (COVID-19), vascular specialists have faced dramatic changes in clinical and surgical practice. Although COVID-19 pulmonary signs and symptoms were the most pertinent problems initially, in the long term, cardiovascular complications became the most fearsome, with poor outcomes in terms of morbidity and mortality. Algorithms and decision-making procedures have been modified, not only to treat new clinical findings in COVID-19 positive patients, but also to avoid complications related to pulmonary and systemic infections. Additionally, COVID-19-negative patients experienced challenging management, due to hospital crowding, the risk of nosocomial COVID-19 transmission, and pandemic emergencies. In this context, aortic interventions were subject to several difficulties. First, in COVID-19-positive patients, there was the onset of new pathological scenarios including thrombotic manifestations and the subsequent complications. Second, in both COVID-19-negative and positive patients, there was a need to deliver optimal treatment with acceptable perioperative risks, forcing a rethinking of decision-making especially in terms of indications for treatments. The aim of this systematic review is to present evidence published on COVID-19 and aortic-related issues, highlighting some challenging aspects regarding management, treatment and outcomes. EVIDENCE ACQUISITION Data search was performed on PubMed, Scopus and Web of Science, using as time range "January 1st, 2000 - May 1st, 2021." Only articles in English language were included. Key words used for the query were "Aorta" AND "COVID-19" OR "SARS-CoV-2." Furthermore, the NCBI database of "SARS-CoV-2 Resources" was interrogated to find further relevant studies. EVIDENCE

SYNTHESIS:

The search retrieved 416 papers; among these, 46 studies were eligible and reviewed in depth. The published literature suggests the existence of a hypercoagulable state in patients with COVID-19 disease occurring via direct and indirect mechanisms. COVID-19 infection seems to promote a prothrombotic status that aggravates vascular disease. Regardless of clinical laboratory or status, active COVID-19 infection is considered a risk factor for poor vascular surgery outcomes. Specifically, it is associated with a fourfold increased risk of death and a threefold increased risk of major adverse events. Prognosis of patients hospitalized with COVID-19 disease is often determined by the extent of pulmonary disease, although vascular complications also greatly affect outcomes. Nevertheless, although COVID­19 is highly morbid, in high­risk operations good outcomes can still be achieved even in elderly patients with COVID­19.

CONCLUSIONS:

In the case of aortic disease during active COVID-19 infection, poor outcomes are associated with COVID-19 vascular and non-vascular complications, while for COVID-19-negative patients not much changed in terms of outcomes, despite the difficulties in management. Endovascular repair, when possible, minimized the impact of treatment, reducing the risk of COVID-related postoperative complications or acquired infection in negative patients.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Aortic Diseases / Vascular Surgical Procedures / Blood Coagulation / Thrombophilia / Endovascular Procedures / COVID-19 / Anticoagulants Type of study: Prognostic study / Reviews / Systematic review/Meta Analysis Topics: Long Covid Limits: Humans Language: English Journal: J Cardiovasc Surg (Torino) Year: 2021 Document Type: Article

Similar

MEDLINE

...
LILACS

LIS


Full text: Available Collection: International databases Database: MEDLINE Main subject: Aortic Diseases / Vascular Surgical Procedures / Blood Coagulation / Thrombophilia / Endovascular Procedures / COVID-19 / Anticoagulants Type of study: Prognostic study / Reviews / Systematic review/Meta Analysis Topics: Long Covid Limits: Humans Language: English Journal: J Cardiovasc Surg (Torino) Year: 2021 Document Type: Article