Massive drop in elective and urgent aortic procedures during the peak of the COVID-19 outbreak in Spanish multicenter analysis.

The coronavirus disease-19 (COVID-19) pandemic has strongly impacted Spain and overwhelmed the healthcare system. Patients with vascular disease and COVID-19 infection are at risk for worse prognosis, given their numerous comorbidities and frequently fragile condition. Aortic-related conditions can be life threatening, especially when acute or complicated and thus, the current situation poses a challenge for providing proper care.

Thirty-four patients were treated for aortic pathology in eight Spanish academic vascular surgery departments during the pandemic between March 14 and May 4; 11 (32%) were urgent, 7 (21%) were semiurgent, and 16 (47%) were elective. Six (33%) of the 18 urgent or semiurgent patients tested positive for COVID-19; four died after repair, two owing to acute respiratory distress syndrome and two because of cardiac shock. Ten of 18 repairs (55%) were performed in nonvascular surgery operating rooms, 12 with nonvascular operating room nursing staff. A dramatic decrease (>50%) of urgent aortic surgery was encountered when compared within the same period for the three previous years.

COVID-19 is likely a risk factor for fatality after aortic repair, although this finding should be confirmed in larger studies. Another study of COVID-positive patients with asymptomatic disease requiring elective repair would also be useful.

The number of patients treated for aortic pathology during the COVID-19 outbreak shows a dramatic decrease, especially so in urgent repairs. This finding could be due to an inability to provide the usual path to care (all preexisting on-call transfer protocols have changed as the COVID-19 patients are prioritized), when patients are unable to reach the right hospital for treatment.

As a new stage of the COVID-19 emergency begins, the challenge will be the treatment of delayed cases. Aortic practice in the future will likely change. Endovascular techniques have proven to be useful and necessary during these times, because they offer rapid recovery while requiring few in-hospital resources. Durability, however, remains a concern, especially for complex aortic cases.