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The Journal of Cardiovascular Surgery 2021 Sep 28

DOI: 10.23736/S0021-9509.21.12049-X


lingua: Inglese

COVID-19 and aortic disease: a practical systematic review of the literature on management and outcomes

Daniele BISSACCO 1 , Chiara LOMAZZI 1, Gianluca BUONGIOVANNI 1, Agnese MAGNI 1, Maurizio DOMANIN 1, 2, Renato CASANA 3, Jean BISMUTH 4, Joost A. van HERWAARDEN 5, Gilbert R. UPCHURCH Jr 6, Santi TRIMARCHI 1, 2

1 Vascular Surgery Unit, IRCCS Ca Granda Ospedale Maggiore Policlinico, Milan, Italy; 2 Department of Clinical and Community Sciences, University of Milan, Milan, Italy; 3 Vascular Surgery Unit, IRCCS Auxologico, Milan, Italy; 4 Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX, USA; 5 Department of Vascular Surgery, University Medical Center, Utrecht, The Netherlands; 6 Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA


Since the advent of the 2019 coronavirus (COVID-19) outbreak, 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 decisionmaking 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.

KEY WORDS: COVID-19; Aortic disease; Vascular surgery; Aortic aneurysm; Aortic dissection

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