Peri-operative SARS-CoV-2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS-CoV-2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre-operative SARS-CoV-2 infection were compared with those without previous SARS-CoV-2 infection. The primary outcome measure was 30-day postoperative mortality. Logistic regression models were used to calculate adjusted 30-day mortality rates stratified by time from diagnosis of SARS-CoV-2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre-operative SARS-CoV-2 diagnosis. Adjusted 30-day mortality in patients without SARS-CoV-2 infection was 1.5% (95%CI 1.4-1.5). In patients with a pre-operative SARS-CoV-2 diagnosis, mortality was increased in patients having surgery within 0-2 weeks, 3-4 weeks and 5-6 weeks of the diagnosis (odds ratio (95%CI) 4.1 (3.3-4.8), 3.9 (2.6-5.1) and 3.6 (2.0-5.2), respectively). Surgery performed ≥ 7 weeks after SARS-CoV-2 diagnosis was associated with a similar mortality risk to baseline (odds ratio (95%CI) 1.5 (0.9-2.1)). After a ≥ 7 week delay in undertaking surgery following SARS-CoV-2 infection, patients with ongoing symptoms had a higher mortality than patients whose symptoms had resolved or who had been asymptomatic (6.0% (95%CI 3.2-8.7) vs. 2.4% (95%CI 1.4-3.4) vs. 1.3% (95%CI 0.6-2.0), respectively). Where possible, surgery should be delayed for at least 7 weeks following SARS-CoV-2 infection. Patients with ongoing symptoms ≥ 7 weeks from diagnosis may benefit from further delay.

SARS-CoV-2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri-operative or prior SARS-CoV-2 were at further increased risk of venous thromboembolism. We conducted a planned sub-study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS-CoV-2 diagnosis was defined as peri-operative (7 days before to 30 days after surgery); recent (1-6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre-operative anti-coagulation for baseline comorbidities was not available. Postoperative venous thromboembolism rate was 0.5% (666/123,591) in patients without SARS-CoV-2; 2.2% (50/2317) in patients with peri-operative SARS-CoV-2; 1.6% (15/953) in patients with recent SARS-CoV-2; and 1.0% (11/1148) in patients with previous SARS-CoV-2. After adjustment for confounding factors, patients with peri-operative (adjusted odds ratio 1.5 (95%CI 1.1-2.0)) and recent SARS-CoV-2 (1.9 (95%CI 1.2-3.3)) remained at higher risk of venous thromboembolism, with a borderline finding in previous SARS-CoV-2 (1.7 (95%CI 0.9-3.0)). Overall, venous thromboembolism was independently associated with 30-day mortality ). In patients with SARS-CoV-2, mortality without venous thromboembolism was 7.4% (319/4342) and with venous thromboembolism was 40.8% (31/76). Patients undergoing surgery with peri-operative or recent SARS-CoV-2 appear to be at increased risk of postoperative venous thromboembolism compared with patients with no history of SARS-CoV-2 infection. Optimal venous thromboembolism prophylaxis and treatment are unknown in this cohort of patients, and these data should be interpreted accordingly.

No abstract

Reportar la experiencia inicial realizando reparación endovascular de la aorta torácica (TEVAR) con doble chimenea en pacientes con disección aórtica Stanford A, los cuales fueron intervenidos previamente con cirugía de urgencia mediante el manejo de la aorta ascendente y el recambio valvular. Material y métodos: Se reporta una serie de seis casos consecutivos de agosto de 2017 a agosto de 2019 a los que se realizó TEVAR con doble chimenea. Se llevó un seguimiento a los 1, 6 y 12 meses. Resultados: En todos se usó C-TAG, en 5 arterias innominadas se desplegó un Viabahn y en 1 caso se colocó una extensión ilíaca Excluder invertida, en todas las carótidas izquierdas se colocó un Viabahn. No hubo mortalidad posquirúrgica, la mortalidad global fue del 16%, y se encontró una endofuga tipo IA en el angiograma final, la cual revirtió a la dilatación con balón. Se presentó hematoma en el 50% de los casos, un paciente cursó con síndrome postimplante. No se identificaron endofugas en el seguimiento a los 6 y 12 meses. A los 12 meses se cuenta con una mortalidad global del 16%. Conclusión: La técnica de doble chimenea es una alternativa de menor morbimortalidad a la cirugía abierta en pacientes con cirugía aórtica ascendente previa. Es necesario realizar nuevos estudios a largo plazo.

La terapia endovascular ofrece menor costo y reducción en la morbimortalidad. El uso del stent medicado Zilver PTX muestra resultados prometedores con permeabilidad del 89.9% a un año. El objetivo es analizar la permeabilidad a 6 meses y la presencia de complicaciones con el uso del stent medicado Zilver PTX en comparación a la derivación femoropoplítea sintética. Métodos: Estudio retrospectivo que abarca dos grupos de 15 pacientes cada uno, con una edad promedio de 66 años, todos presentan diagnóstico de enfermedad arterial periférica (EAP) sintomática. El grupo control fue sometido a revascularización con injerto sintético, mientras el grupo de estudio fue tratado con stent medicado Zilver PTX. Ambos grupos fueron vigilados por un periodo de 6 meses. Resultados: En comparación, ambos métodos son eficaces en el tratamiento de la EAP del sector femoropoplíteo. Para el grupo tratado con stent medicado, se encontró disminución en días de estancia intrahospitalaria y tendencia a incrementar la clase funcional. La permeabilidad primaria fue del 87 vs. el 93% en la derivación abierta y grupo manejado con stent medicado Zilver PTX, respectivamente. Como permeabilidad secundaria se encontró 93% vs. 100%. Conclusiones: Ambos métodos son eficaces para tratar la enfermedad femoropoplítea. Nuestros resultados favorecen el uso de stent medicado en comparación a derivación con injerto sintético.