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1.
BMJ Case Rep ; 15(2)2022 Feb 28.
Article in English | MEDLINE | ID: covidwho-1714388

ABSTRACT

Embolic events causing stroke and intracranial haemorrhage are among the most catastrophic complications of infective endocarditis (IE).A female patient presented with acute unilateral weakness following a 3-month history of fever, for which she had multiple remote consultations with her general practitioner. A brain MRI confirmed a left sided infarct with haemorrhagic transformation. Blood cultures grew Streptococcus mitis and her cardiac imaging showed an aortic valve vegetation with severe aortic regurgitation. Following 2 weeks of antibiotics she developed a new cerebral haemorrhage associated with a mycotic aneurysm which was treated with two coils. After discussions within the multidisciplinary meeting, she underwent aortic valve replacement 3 weeks later. She made a remarkable recovery and was discharged.Our case highlights the importance of face-to-face clinical review in the post-COVID era. It stresses that the management of patients with infective endocarditis and neurological complications is challenging and requires a multidisciplinary approach.


Subject(s)
COVID-19 , Endocarditis, Bacterial , Endocarditis , Remote Consultation , Aortic Valve/diagnostic imaging , Aortic Valve/surgery , Delayed Diagnosis , Endocarditis/complications , Endocarditis/diagnosis , Endocarditis/surgery , Endocarditis, Bacterial/complications , Endocarditis, Bacterial/diagnosis , Endocarditis, Bacterial/drug therapy , Female , Humans , SARS-CoV-2
2.
Catheter Cardiovasc Interv ; 99(6): 1789-1795, 2022 May.
Article in English | MEDLINE | ID: covidwho-1653183

ABSTRACT

Despite advances in transcatheter aortic valve replacement (TAVR) technology, periprocedural stroke remains a complication of TAVR procedures. The TriGUARD 3 device is designed to be positioned in the aortic arch to deflect debris away from the brachiocephalic, left common carotid, and left subclavian arteries during TAVR. The United States Food and Drug Administration (FDA) assembled the Circulatory System Devices Panel to review safety and effectiveness data for the TriGUARD 3 device. Because of the coronavirus disease 2019 pandemic, this meeting was held virtually. In this manuscript, we summarize the data presented by both the sponsor and FDA, as well as the panel discussion.


Subject(s)
Aortic Valve Stenosis , COVID-19 , Embolic Protection Devices , Intracranial Embolism , Transcatheter Aortic Valve Replacement , Aortic Valve/surgery , Aortic Valve Stenosis/surgery , Humans , Intracranial Embolism/etiology , Risk Factors , Transcatheter Aortic Valve Replacement/adverse effects , Treatment Outcome , United States , United States Food and Drug Administration
3.
Int J Cardiol ; 352: 190-194, 2022 04 01.
Article in English | MEDLINE | ID: covidwho-1636840

ABSTRACT

BACKGROUND: The coronavirus 2019 (COVID-19) pandemic upset healthcare systems and their logistics worldwide. We sought to assess safety and effectiveness of an optimized logistics for transcatheter aortic valve implantation (TAVI) pathway developed during the COVID-19 pandemic. METHODS: This is a retrospective analysis. An optimized TAVI logistics based on performing TAVI work-up and procedure during the same hospitalization was used during the COVID-19 pandemic. In-hospital and 30-day outcomes of patients treated during the pandemic were compared with an historical cohort of patients undergoing TAVI with staged work-up before the pandemic within an homogeneous timeframe. RESULTS: Of 536 patients, 227 (42.4%) underwent TAVI during the COVID-19 pandemic with a reduction of 26.5% compared to the pre-pandemic period (n = 309). The median age was 81 (77-85) years and STS score was 3.4 (2.2-5.6)%. Lower rates of in-hospital major vascular complications (2.2% vs. 8.7%; p < 0.01) and life-threatening bleeding (0.4% vs. 4.2%; p = 0.01) were reported in the COVID-19 period, whereas no difference in acute kidney injury (7.0% vs. 7.4%, p = 0.85) rate was reported between COVID-19 and pre-COVID-19 periods. No difference in 30-day rates of all-cause death (4.0 vs. 4.5, p = 0.75) and of major adverse cardiovascular events (4.0 vs. 6.1, p = 0.26) were reported between COVID-19 and pre-COVID-19 periods. CONCLUSIONS: The use of optimized single-hospitalization logistics for TAVI workup and procedure developed during the COVID-19 pandemic, showed to be as safe and effective as the two-stage TAVI pathway previously adopted, allowing the minimization of potential exposure to COVID-19 infection and shortening times to treatment for severely symptomatic patients.


Subject(s)
Aortic Valve Stenosis , COVID-19 , Transcatheter Aortic Valve Replacement , Aged, 80 and over , Aortic Valve/surgery , Aortic Valve Stenosis/surgery , COVID-19/epidemiology , Delivery of Health Care , Humans , Pandemics , Retrospective Studies , SARS-CoV-2 , Transcatheter Aortic Valve Replacement/methods , Treatment Outcome
4.
Am Heart J ; 243: 77-86, 2022 01.
Article in English | MEDLINE | ID: covidwho-1536405

ABSTRACT

BACKGROUND: Regulatory agencies have endorsed more limited approaches to clinical trial site monitoring. However, the impact of different monitoring strategies on trial conduct and outcomes is unclear. METHODS: We conducted a patient-level block-randomized controlled trial evaluating the effect of intensive versus limited monitoring on cardiovascular clinical trial conduct and outcomes nested within the CoreValve Continued Access and Expanded Use Studies. Intensive monitoring included complete source data verification of all critical datapoints whereas limited monitoring included automated data checks only. This study's endpoints included clinical trial outcome ascertainment as well as monitoring action items, protocol deviations, and adverse event ascertainment. RESULTS: A total of 2,708 patients underwent transcatheter aortic valve replacement (TAVR) and were randomized to either intensive monitoring (n = 1,354) or limited monitoring (n = 1,354). Monitoring action items were more common with intensive monitoring (52% vs 15%; P < .001), but there was no difference in the percentage of patients with any protocol deviation (91.6% vs 90.4%; P = .314). The reported incidence of trial outcomes between intensive and limited monitoring was similar for mortality (30 days: 4.8% vs 5.5%, P = .442; 1 year: 20.3% vs 21.3%, P = .473) and stroke (30 days: 2.8% vs 2.4%, P = .458), as well as most secondary trial outcomes with the exception of bleeding (intensive: 36.3% vs limited: 32.0% at 30 days, P = .019). There was a higher reported incidence of cardiac adverse events reported in the intensive monitoring group at 1 year (76.7% vs 72.4%; P = .019). CONCLUSIONS: Tailored limited monitoring strategies can be implemented without influencing the integrity of TAVR trial outcomes.


Subject(s)
Aortic Valve Stenosis , Heart Valve Prosthesis , Stroke , Transcatheter Aortic Valve Replacement , Aortic Valve/surgery , Heart Valve Prosthesis/adverse effects , Humans , Incidence , Risk Factors , Stroke/epidemiology , Stroke/etiology , Stroke/prevention & control , Transcatheter Aortic Valve Replacement/methods , Treatment Outcome
5.
Clin Cardiol ; 44(10): 1344-1353, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1453560

ABSTRACT

BACKGROUND: The use of transcatheter aortic valve implantation (TAVI) for treating aortic stenosis (AS) has increased exponentially in recent years. Despite the availability of clinical practice guidelines for the management of valvular heart disease, disparities in quality of care (QoC) for TAVI patients remain widespread across Europe. Tailored QoC measures will help to reduce resource utilization and improve patient outcomes without compromising patient safety. Using a clear set of QoC measures, the BENCHMARK registry aims to document the progress that can be achieved if such tailored QoC measures are implemented. METHODS: The BENCHMARK registry (BENCHMARK) is a non-interventional, multicenter registry in patients with severe symptomatic AS undergoing TAVI with a 1- and 12-months follow-up. BENCHMARK will be conducted at 30 centers across Europe and will enroll a total of 2400 consecutive TAVI patients. Patients suffering from severe symptomatic AS who undergo TAVI with a balloon-expandable transcatheter aortic valve will be included. The registry will comprise four phases: (1) a retrospective baseline evaluation phase; (2) an education phase; (3) an implementation phase; and (4) a prospective effect documentation phase (prospective phase). The registry's primary objectives are to reduce the length of hospital stay and accelerate the post-procedural patient recovery pathway, but without compromising safety. The study started in April 2021 and has an estimated completion date of May 2023. DISCUSSION: BENCHMARK will establish QoC measures to reduce resource utilization, intensive care unit bed occupancy, and overall length of hospitalization with uncompromised patient safety post-TAVI (ClinicalTrials.gov Identifier: NCT04579445).


Subject(s)
Aortic Valve Stenosis , Transcatheter Aortic Valve Replacement , Aortic Valve/surgery , Aortic Valve Stenosis/surgery , Benchmarking , Europe , Humans , Prospective Studies , Registries , Retrospective Studies , Time Factors , Transcatheter Aortic Valve Replacement/adverse effects , Treatment Outcome
6.
BMC Cardiovasc Disord ; 21(1): 434, 2021 09 14.
Article in English | MEDLINE | ID: covidwho-1413998

ABSTRACT

BACKGROUND: The coronavirus-disease 2019 (COVID-19) pandemic imposed an unprecedented burden on the provision of cardiac surgical services. The reallocation of workforce and resources necessitated the postponement of elective operations in this cohort of high-risk patients. We investigated the impact of this outbreak on the aortic valve surgery activity at a single two-site centre in the United Kingdom. METHODS: Data were extracted from the local surgical database, including the demographics, clinical characteristics, and outcomes of patients operated on from March 2020 to May 2020 with only one of the two sites resuming operative activity and compared with the respective 2019 period. A similar comparison was conducted with the period between June 2020 and August 2020, when operative activity was restored at both institutional sites. The experience of centres world-wide was invoked to assess the efficiency of our services. RESULTS: There was an initial 38.2% reduction in the total number of operations with a 70% reduction in elective cases, compared with a 159% increase in urgent and emergency operations. The attendant surgical risk was significantly higher [median Euroscore II was 2.7 [1.9-5.2] in 2020 versus 2.1 [0.9-3.7] in 2019 (p = 0.005)] but neither 30-day survival nor freedom from major post-operative complications (re-sternotomy for bleeding/tamponade, transient ischemic attack/stroke, renal replacement therapy) was compromised (p > 0.05 for all comparisons). Recommencement of activity at both institutional sites conferred a surgical volume within 17% of the pre-COVID-19 era. CONCLUSIONS: Our institution managed to offer a considerable volume of aortic valve surgical activity over the first COVID-19 outbreak to a cohort of higher-risk patients, without compromising post-operative outcomes. A backlog of elective cases is expected to develop, the accommodation of which after surgical activity normalisation will be crucial to monitor.


Subject(s)
Aortic Valve/surgery , COVID-19 , Cardiac Surgical Procedures/trends , Heart Valve Diseases/surgery , Outcome and Process Assessment, Health Care/trends , Practice Patterns, Physicians'/trends , Surgeons/trends , Aged , Aged, 80 and over , Cardiac Surgical Procedures/adverse effects , Cardiac Surgical Procedures/mortality , Databases, Factual , Elective Surgical Procedures/trends , Female , Heart Valve Diseases/mortality , Humans , London , Male , Middle Aged , Patient Safety , Postoperative Complications/etiology , Retrospective Studies , Risk Assessment , Risk Factors , Time Factors , Treatment Outcome
7.
BMC Cardiovasc Disord ; 21(1): 434, 2021 09 14.
Article in English | MEDLINE | ID: covidwho-1406707

ABSTRACT

BACKGROUND: The coronavirus-disease 2019 (COVID-19) pandemic imposed an unprecedented burden on the provision of cardiac surgical services. The reallocation of workforce and resources necessitated the postponement of elective operations in this cohort of high-risk patients. We investigated the impact of this outbreak on the aortic valve surgery activity at a single two-site centre in the United Kingdom. METHODS: Data were extracted from the local surgical database, including the demographics, clinical characteristics, and outcomes of patients operated on from March 2020 to May 2020 with only one of the two sites resuming operative activity and compared with the respective 2019 period. A similar comparison was conducted with the period between June 2020 and August 2020, when operative activity was restored at both institutional sites. The experience of centres world-wide was invoked to assess the efficiency of our services. RESULTS: There was an initial 38.2% reduction in the total number of operations with a 70% reduction in elective cases, compared with a 159% increase in urgent and emergency operations. The attendant surgical risk was significantly higher [median Euroscore II was 2.7 [1.9-5.2] in 2020 versus 2.1 [0.9-3.7] in 2019 (p = 0.005)] but neither 30-day survival nor freedom from major post-operative complications (re-sternotomy for bleeding/tamponade, transient ischemic attack/stroke, renal replacement therapy) was compromised (p > 0.05 for all comparisons). Recommencement of activity at both institutional sites conferred a surgical volume within 17% of the pre-COVID-19 era. CONCLUSIONS: Our institution managed to offer a considerable volume of aortic valve surgical activity over the first COVID-19 outbreak to a cohort of higher-risk patients, without compromising post-operative outcomes. A backlog of elective cases is expected to develop, the accommodation of which after surgical activity normalisation will be crucial to monitor.


Subject(s)
Aortic Valve/surgery , COVID-19 , Cardiac Surgical Procedures/trends , Heart Valve Diseases/surgery , Outcome and Process Assessment, Health Care/trends , Practice Patterns, Physicians'/trends , Surgeons/trends , Aged , Aged, 80 and over , Cardiac Surgical Procedures/adverse effects , Cardiac Surgical Procedures/mortality , Databases, Factual , Elective Surgical Procedures/trends , Female , Heart Valve Diseases/mortality , Humans , London , Male , Middle Aged , Patient Safety , Postoperative Complications/etiology , Retrospective Studies , Risk Assessment , Risk Factors , Time Factors , Treatment Outcome
9.
Cardiovasc Revasc Med ; 28S: 68-71, 2021 07.
Article in English | MEDLINE | ID: covidwho-1176553

ABSTRACT

In 2020, the coronavirus disease 2019 (COVID-19) pandemic has led to a decrease in interventional treatment for structural heart disease worldwide. In this context, the management of patients with symptomatic severe aortic stenosis (AS) or bioprosthetic valve dysfunction (BVD) represents a clinical challenge, as a delay in aortic valve replacement procedures may increase short-term morbidity and mortality. We report four cases of TAVR performed in patients with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection. All of them were discharged in good clinical conditions and no adverse events were reported at 30 days follow-up. Our experience suggests that in selected patients with mild SARS-CoV-2 infection and symptomatic native AS or BVD, TAVR has a favorable short-term outcome.


Subject(s)
Aortic Valve Stenosis , COVID-19 , Heart Valve Prosthesis , Transcatheter Aortic Valve Replacement , Aortic Valve/diagnostic imaging , Aortic Valve/surgery , Aortic Valve Stenosis/diagnostic imaging , Aortic Valve Stenosis/surgery , Feasibility Studies , Humans , Risk Factors , SARS-CoV-2 , Transcatheter Aortic Valve Replacement/adverse effects , Treatment Outcome
10.
Open Heart ; 8(1)2021 03.
Article in English | MEDLINE | ID: covidwho-1153699

ABSTRACT

Transcatheter aortic valve implantation (TAVI) is a proven treatment for life-threatening aortic valve disease, predominantly severe aortic stenosis. However, even among developed nations, access to TAVI is not uniform. The Valve for Life initiative was launched by the European Association of Percutaneous Cardiovascular Interventions in 2015 with the objective of improving access to transcatheter valve interventions across Europe. The UK has been identified as a country with low penetration of these procedures and has been selected as the fourth nation to be included in the initiative. Specifically, the number of TAVI procedures carried out in the UK is significantly lower than almost all other European nations. Furthermore, there is substantial geographical inequity in access to TAVI within the UK. As a consequence of this underprovision, waiting times for TAVI are long, and mortality among those waiting intervention is significant. This article reviews these issues, reports new data on access to TAVI in the UK and presents the proposals of the UK Valve for Life team to address the current problems in association with the British Cardiovascular Intervention Society.


Subject(s)
Aortic Valve Stenosis/surgery , Aortic Valve/surgery , Heart Valve Prosthesis , Transcatheter Aortic Valve Replacement/methods , Aortic Valve Stenosis/epidemiology , Humans , Incidence , Risk Factors , United Kingdom
11.
Catheter Cardiovasc Interv ; 98(5): E733-E736, 2021 11 01.
Article in English | MEDLINE | ID: covidwho-1059412

ABSTRACT

OBJECTIVES: The current report describes a single operator's experience of the first use of smartglass technology as a facilitator of virtual support during TAVR proctoring. BACKGROUND: Restricted gatherings and containment measures during the ongoing COVID-19 pandemic have a major impact on daily clinical practice. Interaction between peers is crucial in science, clinical practice, and education. In addition, there is also a growing importance of proctoring in interventional cardiology for structural heart disease. Virtual support may facilitate the wide implementation of remote proctoring. METHODS: A collaboration between a smartglass provider (Rods & Cones) and self-expandable transcatheter aortic heart valve system (Medtronic) was initiated and tested extensively prior to TAVR procedures. Two cases were randomly selected for remote support. The light-weight smartglass consisted of a full HD central camera, a 720p ×5 optical zoom camera, built-in LED light, speaker and earphone jack, and an external visor to project data in a nonobstructive manner in the operators' view. RESULTS: Preprocedural detailed discussion of the cases between the proctor and the operator occurred via teleconferencing. Successful procedural virtual support was determined by the presence of a session coordinator, high quality of the central camera, high-speed and stable wireless internet connection. Limitations were the relative discomfort of the earpieces, discordance between the central and zoom camera and the absence of visual fixation during head motions. CONCLUSION: In a highly complex and demanding context such as TAVR, remote proctoring by means of virtual support is feasible and efficacious.


Subject(s)
Aortic Valve Stenosis , COVID-19 , Heart Valve Prosthesis , Transcatheter Aortic Valve Replacement , Aortic Valve/diagnostic imaging , Aortic Valve/surgery , Aortic Valve Stenosis/diagnostic imaging , Aortic Valve Stenosis/surgery , Humans , Pandemics , Risk Factors , SARS-CoV-2 , Transcatheter Aortic Valve Replacement/adverse effects , Treatment Outcome
12.
Am J Cardiol ; 145: 97-101, 2021 04 15.
Article in English | MEDLINE | ID: covidwho-1032332

ABSTRACT

Transcatheter aortic valve implantation (TAVI) outcomes during the coronavirus disease 2019 (COVID-19) pandemic have not been fully evaluated and some structural programs in the world have been suspended during this period. We sought to evaluate and compare clinical outcomes in patients undergoing TAVI in pandemic versus nonpandemic era. In a single center, we compared 198 TAVI patients performed during 2019 to 59 patients performed during the COVID-19 pandemic period (March 1st to June 30th, 2020). Primary outcome was procedural success according to VARC criteria and 30-day mortality rates. VARC-defined procedural success was high in both groups (93.3% vs 96.6%; p = 0.53). There were no differences in any vascular complications (26% vs 19%; p = 0.3), permanent pacemaker implantation (11.8% vs 15.3%; p = 0.63), and length of hospital stay (5.2 vs 4.2 days; p = 0.29). Thirty-day mortality was similar (3% vs 3.4%; p = 1.0). We had no documented COVID-19 disease in our patients during follow up. In conclusion, TAVI procedures can be performed effectively and safely during the COVID-9 pandemic, using a minimalist approach, early discharge, and by maintaining proper use of personal protective equipment.


Subject(s)
Aortic Valve/surgery , COVID-19/epidemiology , Heart Valve Diseases/surgery , Pandemics , Registries , Transcatheter Aortic Valve Replacement/methods , Aged, 80 and over , Comorbidity , Female , Heart Valve Diseases/epidemiology , Humans , Male , Retrospective Studies , SARS-CoV-2 , Treatment Outcome
13.
Catheter Cardiovasc Interv ; 97(5): 940-947, 2021 04 01.
Article in English | MEDLINE | ID: covidwho-1001835

ABSTRACT

OBJECTIVES: We sought to evaluate the safety, efficacy and feasibility of same-day discharge after uncomplicated, minimalist TAVR. BACKGROUND: At the start of the COVID-19 pandemic, we created a same-day discharge (SDD) pathway after conscious sedation, transfemoral (minimalist) TAVR to help minimize risk of viral transmission and conserve hospital resources. Studies support that next-day discharge (NDD) for carefully selected patients following minimalist TAVR is safe and feasible. There is a paucity of data regarding the safety of SDD after TAVR. METHODS: In-hospital and 30 day outcomes of consecutive patients meeting pre-specified criteria for SDD after minimalist TAVR at our institution between March and July of 2020 were reviewed. Outcomes were compared to a NDD cohort from July 2018 through July 2020 that would have met SDD criteria. Primary endpoints were mortality, delayed pacemaker placement, stroke and cardiovascular readmission at 30 days. RESULTS: Twenty nine patients were discharged via the SDD pathway after TAVR. 128 prior NDD patients were identified who met all criteria for SDD. The STS scores were similar between the two groups (SDD 2.6% ±1.5 vs. NDD 2.3% ± 1.2). There were no deaths at 30 days in either group. There was no significant difference in delayed pacemaker placement (SDD 0% vs. NDD 0.8%, p > .99) or cardiovascular readmission (SDD 0% vs. NDD 5.5%, p = .35) at 30 days. CONCLUSIONS: Same day discharge following uncomplicated, minimalist TAVR in selected patients appears to be safe, achieving similar 30 day outcomes as a cohort of next day discharge patients.


Subject(s)
Aortic Valve Stenosis/surgery , COVID-19/epidemiology , Pandemics , Patient Discharge/trends , Risk Assessment/methods , Transcatheter Aortic Valve Replacement/methods , Aged , Aortic Valve/surgery , Aortic Valve Stenosis/epidemiology , Comorbidity , Female , Follow-Up Studies , Humans , Length of Stay/trends , Male , Retrospective Studies , Risk Factors , Time Factors
14.
Cardiovasc Revasc Med ; 31: 26-31, 2021 10.
Article in English | MEDLINE | ID: covidwho-956955

ABSTRACT

BACKGROUND: The risk of nosocomial COVID-19 infection for vulnerable aortic stenosis patients and intensive care resource utilization has led to cardiac surgery deferral. Untreated severe symptomatic aortic stenosis has a dismal prognosis. TAVR offers an attractive alternative to surgery as it is not reliant on intensive care resources. We set out to explore the safety and operational efficiency of restructuring a TAVR service and redeploying it to a new non-surgical site during the COVID-19 pandemic. METHODS: The institutional prospective service database was retrospectively interrogated for the first 50 consecutive elective TAVR cases prior to and after our institution's operational adaptations for the COVID-19 pandemic. Our endpoints were VARC-2 defined procedural complications, 30-day mortality or re-admission and service efficiency metrics. RESULTS: The profile of patients undergoing TAVR during the pandemic was similar to patients undergoing TAVR prior to the pandemic with the exception of a lower mean age (79 vs 82 years, p < 0.01) and median EuroScore II (3.1% vs 4.6%, p = 0.01). The service restructuring and redeployment contributed to the pandemic-mandated operational efficiency with a reduction in the distribution of pre-admission hospital visits (3 vs 3 visits, p < 0.001) and the time taken from TAVR clinic to procedure (26 vs 77 days, p < 0.0001) when compared to the pre-COVID-19 service. No statistically significant difference was noted in peri-procedural complications and 30-day outcomes, while post-operative length of stay was significantly reduced (2 vs 3 days, p < 0.0001) when compared to pre-COVID-19 practice. CONCLUSIONS: TAVR service restructuring and redeployment to align with pandemic-mandated healthcare resource rationalization is safe and feasible.


Subject(s)
Aortic Valve Stenosis , COVID-19 , Heart Valve Prosthesis Implantation , Transcatheter Aortic Valve Replacement , Aged, 80 and over , Aortic Valve/surgery , Aortic Valve Stenosis/diagnostic imaging , Aortic Valve Stenosis/epidemiology , Aortic Valve Stenosis/surgery , Humans , Pandemics , Prospective Studies , Retrospective Studies , Risk Factors , SARS-CoV-2 , Time Factors , Transcatheter Aortic Valve Replacement/adverse effects , Treatment Outcome
15.
J Card Surg ; 36(1): 260-264, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-901100

ABSTRACT

COVID-19 has had a dramatic impact on the provision of healthcare. COVID-19 can manifest with cardiac and thrombotic presentations. Additionally, patients with cardiovascular comorbidities are at an increased risk of adverse outcomes related to COVID-19 infection. This in turn has led to a significant reduction in the provision of cardiac surgery with alternative management options utilized to address patients with significant disease. In terms of aortic valve disease, transcatheter aortic valve implantation (TAVI) provides advantages over surgical aortic valve replacement in with a lower burden on healthcare resources. COVID-19 also resulted in changes in management strategies and as such TAVI is now being considered in younger- and low-risk patients. However, long term data with regard to TAVI is still unknown, and the use in patient groups that have been excluded in the large pivotal studies that established TAVI as an alternative to surgery has raised specific concerns in the use of TAVI as the preferred treatment choice. With the long term ramification unknown, it is essential that decisions are made with caution.


Subject(s)
Aortic Valve Stenosis/surgery , Aortic Valve/surgery , COVID-19/epidemiology , Heart Valve Prosthesis/standards , Postoperative Complications/epidemiology , Transcatheter Aortic Valve Replacement/standards , Aortic Valve Stenosis/epidemiology , Comorbidity , Global Health , Humans , Incidence , Pandemics , Risk Factors
16.
J Card Surg ; 36(1): 48-55, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-883273

ABSTRACT

BACKGROUND AND AIM OF THE STUDY: The coronavirus disease 2019 (COVID-19) pandemic has put an enormous strain on healthcare systems and intensive care unit (ICU) capacity, leading to suspension of most elective procedures, including transcatheter aortic valve replacement (TAVR). However, deferment of TAVR is associated with significant wait-time mortality in patients with severe aortic valve stenosis. Conversely, there is currently no data available regarding the safety and feasibility of a continued TAVR program during this unprecedented crisis. The aim of this study is to evaluate the safety and feasibility of patients undergoing TAVR during the COVID-19 pandemic in our center, with specific emphasis on COVID-19 related outcomes. METHODS: All patients who underwent TAVR in our center between February 27, 2020, and June 30, 2020, were evaluated. Clinical outcomes were described in terms of Valve Academic Research Consortium 2 definitions. Patient follow-up was done by chart review and telephone survey. RESULTS: A total of 71 patients have undergone TAVR during the study period. Median age was 80 years, 63% were men, and 25% were inpatients. Procedural success was 99%. After TAVR, 30% involved admission to the ICU, and 94% were ultimately discharged to the cardiac care unit on the same day. Two patients (3%) had confirmed COVID-19 a few days after TAVR, and both died of COVID-19 pneumonia within 2 weeks after hospital discharge. CONCLUSIONS: A continued TAVR program during the COVID-19 pandemic is feasible despite limited hospital resources. However, COVID-19 related mortality after TAVR is of concern.


Subject(s)
Aortic Valve Stenosis/surgery , Aortic Valve/surgery , COVID-19/epidemiology , Pandemics , SARS-CoV-2 , Transcatheter Aortic Valve Replacement/methods , Aged , Aged, 80 and over , Aortic Valve Stenosis/epidemiology , Comorbidity , Female , Humans , Male , Netherlands , Retrospective Studies , Treatment Outcome
20.
JACC Cardiovasc Interv ; 13(16): 1937-1944, 2020 08 24.
Article in English | MEDLINE | ID: covidwho-457057

ABSTRACT

The novel coronavirus disease-2019 (COVID-19) pandemic has created uncertainty in the management of patients with severe aortic stenosis. This population experiences high mortality from delays in treatment of valve disease but is largely overlapping with the population of highest mortality from COVID-19. The authors present strategies for managing patients with severe aortic stenosis in the COVID-19 era. The authors suggest transitions to virtual assessments and consultation, careful pruning and planning of necessary testing, and fewer and shorter hospital admissions. These strategies center on minimizing patient exposure to COVID-19 and expenditure of human and health care resources without significant sacrifice to patient outcomes during this public health emergency. Areas of innovation to improve care during this time include increased use of wearable and remote devices to assess patient performance and vital signs, devices for facile cardiac assessment, and widespread use of clinical protocols for expedient discharge with virtual physical therapy and cardiac rehabilitation options.


Subject(s)
Aortic Valve Stenosis/surgery , Aortic Valve/surgery , Coronavirus Infections/complications , Pandemics , Pneumonia, Viral/complications , Transcatheter Aortic Valve Replacement/methods , Aortic Valve Stenosis/complications , Aortic Valve Stenosis/mortality , Betacoronavirus , COVID-19 , Coronavirus Infections/epidemiology , Global Health , Hospital Mortality/trends , Humans , Pneumonia, Viral/epidemiology , Risk Factors , SARS-CoV-2
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