ABSTRACT
Background: Transthyretin cardiac amyloidosis (ATTR-CM) is important comorbidity associated with severe aortic stenosis (AS). Multiple studies have shown that ATTR-CM was present in 10-15% of all cases with severe AS. The purpose of this quality improvement project is to raise awareness of ATTR-CM in patients who underwent transcatheter aortic valve replacement (TAVR) for severe AS amongst the healthcare providers and patients. Methods: We retrospectively reviewed all TAVR cases performed at our institution in 2019 (Total cases 87). We screened for the presence of predefined high-risk features for ATTR-CM based on prior literature (Presence of diastolic dysfunction, left ventricular hypertrophy on echocardiogram, low voltage-mass ratio, low limb lead voltage on EKG, arrhythmia/bundle branch block, or systemic symptoms of amyloidosis). We subsequently contacted the patients to discuss our clinical suspicion of ATTR-CM and offered clinical referral to a cardiac amyloid specialist. Results: Of the total of 87 patients who underwent TAVR in 2019, 12 patients were deceased at chart review. We have identified 50 patients (66.7%) who had high-risk features of ATTR-CM. A total of 17 patients (34% of 50 patients) agreed to be referred to cardiac amyloid specialist. Six patients (12%) were tested with 99m Technetium Pyrophosphate imaging, and all were negative for ATTR-CM. Eleven patients (22%) are still pending testing. Six patients did not wish for referral due to personal reasons. We were not able to reach 15 patients via phone (30%). In addition, we have found additional 12 patients who were deceased (Total mortality count of 24, 27.5%) in two years. Conclusion: Our project has increased awareness within structural cardiologists as we have implemented a prospective screening process within our institution. While we expected to diagnose ATTR-CM in 10% of severe AS who underwent TAVR, we had multiple difficulties contacting them, coordinating referrals due to the COVID-19 pandemic and higher 2-year mortality. We are hypothesizing whether the higher 2-year mortality is secondary to undetected ATTR-CM. We are planning for screening and timely referral for patients who underwent TAVR more recently.
ABSTRACT
BACKGROUND: Percutaneous left atrial appendage occlusion (LAAO) with the Watchman device is FDA approved for stroke prevention in patients with nonvalvular atrial fibrillation who have an appropriate indication. During the COVID-19 pandemic, a same-day discharge protocol (SDDP) was employed to improve resource utilization, relieve hospital occupation, and reduce the possible risk of in-hospital virus transmission. OBJECTIVES: We sought to analyze the safety, feasibility, and cost effectiveness for SDDP in patients receiving LAAO. METHODS: A prospective analysis of 142 consecutive patients, 119 treated prior to SDDP and 23 who underwent SDDP following LAAO with cardiac computed tomography angiography (CTA)-guided pre-procedural planning and intracardiac echocardiogram (ICE). Procedures were performed in a single, large academic hospital in the United States. In-hospital and 45-day procedural success, adverse events, length of procedure, and length-of-stay were evaluated. RESULTS: Baseline patient characteristics including mean CHA2DS2VASc scores and mean HAS-BLED scores were similar in both groups. All procedures were successful. There was no significant difference in rates of procedural complications or in-hospital adverse events. The mean procedure time in the SDDP group was 11 minutes longer than in the conventional group (62.1 ± 5.9 vs 51.1 ± 21;P=.01). Outcomes at 45-day follow-up were similar. SDDP was associated with a reduced length of stay compared with conventional strategy and a 15% reduction in total costs. CONCLUSIONS: Same-day discharge strategy for LAAO appears safe, feasible and could become the new standard approach for LAAO. A protocol including CTA pre-procedural planning, ICE-guided deployment and conscious sedation reduces hospital occupation and lowers costs.
ABSTRACT
Background: Left atrial appendage occlusion (LAAO) WATCHMAN™ device is approved for stroke prevention in nonvalvular atrial fibrillation as a rational alternative to oral anticoagulation. During the COVID-19 pandemic, a same-day-discharge strategy reduces resource utilization, relieves hospital occupation, and possibly reduces the risk of in-hospital transmission. We sought to analyze the feasibility for the implementation of a same-day-discharge protocol in a series of patients receiving LAAO with cardiac computed tomography angiography (CTA)-guided pre-procedural planning and intra-cardiac echocardiography (ICE)-guided device deployment in patients under conscious sedation. Methods: A prospective analysis of 20 consecutive patients who underwent same-day discharge following LAAO over a 6-month period with cardiac CTA-guided pre-procedural planning and ICE was conducted. Procedures were performed in a large academic hospital in the United States. Procedural success, adverse events, length of procedure, and length of stay were evaluated. Results: The same-day-discharge protocol was implemented for all 20 patients (100%) successfully, 12 (60%) with WATCHMAN™ 2.5 devices and 8 (40%) using the next-generation WATCHMAN™ FLX platform. The mean CHA2DS2VASc score was 4.2±1.2 and the mean HAS-BLED score was 3.9±0.9. All deployments were sized on the basis of pre-procedural CTA and were ICE-guided, with 100% success, with the patients under conscious sedation. Hence, there was no need for trans-esophageal echocardiogram, intubation, or mechanical ventilation. No adverse events occurred. Conclusions: The same-day-discharge strategy is feasible and may play an important role in the COVID-19 era. A protocol including CTA pre-procedural planning, ICE-guided deployment, and conscious sedation reduces hospital occupation and lowers costs. [Formula presented]
ABSTRACT
The disease caused by the new SARS-CoV-2 coronavirus, called COVID-19, has already infected more than 6.5 million people worldwide. To date, there is no proven effective treatment against the virus, but some drugs already used in other diseases have shown effectiveness in vitro or even in humans, such as some antimicrobial agents. The objective of this bibliographic research was to provide an overview of the published evidence, up to the research date, about experimental studies and clinical trials that used antimicrobial drugs as a treatment proposal for the disease by the new coronavirus. 75 articles from Journals indexed in the MEDLINE database were included. The results showed that the drugs Lopinavir/Ritonavir, chloroquine and hydroxychloroquine demonstrated to act in the clinical improvement of patients diagnosed with COVID-19. However, more evidence is needed to confirm the data currently available.