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May 15, 2020

Study in NYC Shows Decrease in Acute Type A Aortic Dissection Surgeries During COVID-19 Pandemic

May 15, 2020—The American College of Cardiology (ACC) announced the publication of a study showing that the monthly case volume of surgical repair of acute type A aortic dissections in New York, New York, significantly decreased after the COVID-19 outbreak. This finding raises concerns about the public health impact of the pandemic, according to the report by Ismail El-Hamamsy, MD, et al in the Journal of the American College of Cardiology (JACC).

According to the ACC press release, to investigate the impact of COVID-19 on the incidence of acute type A aortic dissections, the study was composed of data from the 11 hospitals and health systems in New York City that provide cardiac surgical services. The investigators captured all cases of surgical repair from January 1, 2018 to April 15, 2020, using March 1, 2020, as the post-COVID date to correspond to the first reported COVID-19 case in the city.

During the study period, none of the 11 facilities reported changes in the management of acute type A aortic dissections cases. All patients who presented at the 11 facilities with an acute type A aortic dissection underwent emergent surgical repair.

Surgical repair of acute type A aortic dissection decreased 76.5%, from 12.8 ± 4.6 cases per month before the pandemic to 3 ± 1 cases per month after the pandemic. The decline of 9.8 cases was statistically significant (95% CI, 2.95–16.67; P = .007). In addition, low volumes in March and April 2020, confirmed the “unusual nature of this observation.”

As noted in the ACC announcement, the investigators stated that a causal relationship between the decrease in surgeries, the beginning of the pandemic, and an increase in at-home deaths in the last week of March 2020 cannot be “firmly established,” but the study “gives pause for thought.” The investigators further advise that the findings underscore the need to balance social distancing with the importance of seeking medical treatment when sudden, severe symptoms present. The decrease in patients presenting with type A aortic dissections “serves as a word of caution for cities yet to experience a surge in COVID-19 cases, as well as in future similar events,” concluded the investigators in JACC.

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