The monthly case volume of surgical repair of acute type A aortic dissections in New York, NY, decreased significantly after the COVID-19 outbreak began, raising concerns about the public health impact of the pandemic, according to a report published May 14 in the Journal of the American College of Cardiology.

Ismail El-Hamamsy, MD, PhD, et al., compiled data from all 11 hospitals and health systems in New York that provide cardiac surgical services to investigate the impact of COVID-19 on the incidence of acute type A aortic dissections.

The researchers captured all cases of surgical repair from Jan. 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 entire study period, none of the 11 facilities reported changes in management of acute type A aortic dissections cases. All patients presenting 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% after the COVID-19 pandemic began, from 12.8 ± 4.6 cases per month before the pandemic to 3 ± 1 case per month after the pandemic.

The decline was statistically significant (9.8; 95% confidence interval, 2.95-16.67; p=0.007). In addition, low volumes in March and April 2020, confirmed the "unusual nature of this observation."

Although a causal relationship between the decrease in type A aortic dissections, the beginning of the COVID-19 pandemic in New York and an increase in at-home deaths in the last week of March 2020, cannot be "firmly established," the study "gives pause for thought," the researchers write.

The findings underscore the need to balance social distancing with the importance of seeking medical treatment when sudden, severe symptoms present, they note. 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," they conclude.

Clinical Topics: Cardiac Surgery, Cardiovascular Care Team, COVID-19 Hub, Invasive Cardiovascular Angiography and Intervention, Vascular Medicine, Interventions and Vascular Medicine

Keywords: COVID-19, Coronavirus, Coronavirus Infections, Pandemics, Public Health, New York, severe acute respiratory syndrome coronavirus 2, Aneurysm, Dissecting, Cardiac Surgical Procedures, Cardiology

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