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1.
Monaldi Arch Chest Dis ; 92(2)2021 Dec 03.
Article in English | MEDLINE | ID: covidwho-1556232

ABSTRACT

Stuck valve is a very rare and severe complication that occurs in mechanical valve replacement patients with ineffective anticoagulation. However, with COVID-19 restriction measures, it became challenging to regularly assess INR to make sure it falls within the target therapeutic range to prevent this complication. We present a series of 10 patients who either underwent transthoracic echocardiography for a suspected stuck valve or were seen at the outpatient valve clinic with the residual consequences of a stuck valve during the COVID-19 restriction measures in our institute. Stuck prosthetic valves incident has increased significantly during this period, particularly those in the mitral position for which urgent replacement and prolonged hospitalization were necessary. Particularly with the COVID-19 restrictions in place, these cases highlight the need for physicians to be aware of the dramatic increase in the incidence of stuck prosthetic valves in patients on chronic warfarin therapy.


Subject(s)
COVID-19 , Heart Valve Prosthesis Implantation , Heart Valve Prosthesis , Anticoagulants/therapeutic use , Echocardiography , Heart Valve Prosthesis/adverse effects , Humans , Incidence
3.
Cardiovasc Revasc Med ; 28S: 54-56, 2021 07.
Article in English | MEDLINE | ID: covidwho-1368596

ABSTRACT

Undertreatment of patients with severe mitral regurgitation (MR) has been exaggerated during the coronavirus disease of 2019 (COVID-19) pandemic. Expedited workup and shortened post-procedural hospital stay after percutaneous mitral valve repair (PMVR) would be incredibly helpful to relieve the constrain in the era of the COVID-19 pandemic and immediately afterward. We report a patient who underwent PMVR with a simplified pre-operative workup, a shortened hospital stay, and expedited discharge.


Subject(s)
COVID-19 , Heart Valve Prosthesis Implantation , Mitral Valve Insufficiency , Heart Valve Prosthesis Implantation/adverse effects , Humans , Mitral Valve/diagnostic imaging , Mitral Valve/surgery , Mitral Valve Insufficiency/diagnostic imaging , Mitral Valve Insufficiency/surgery , Pandemics , Patient Discharge , SARS-CoV-2 , Treatment Outcome
5.
Int J Environ Res Public Health ; 18(13)2021 07 04.
Article in English | MEDLINE | ID: covidwho-1302318

ABSTRACT

Wearable devices (WDs) can objectively assess patient-reported outcomes (PROMs) in clinical trials. In this study, the feasibility and acceptability of using commercial WDs in elderly patients undergoing transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR) will be explored. This is a prospective observational study. Participants were trained to use a WD and a smartphone to collect data on their physical activity, rest heart rate and number of hours of sleep. Validated questionnaires were also used to evaluate these outcomes. A technology acceptance questionnaire was used at the end of the follow up. In our participants an overall good compliance in wearing the device (75.1% vs. 79.8%, SAVR vs. TAVR) was assessed. Half of the patients were willing to continue using the device. Perceived ease of use is one of the domains that scored higher in the technology acceptance questionnaire. In this study we observed that the use of a WD is accepted in our frail population for an extended period. Even though commercial WDs are not tailored for clinical research, they can produce useful information on patient behavior, especially when coordinated with intervention tailored to the single patient.


Subject(s)
Aortic Valve Stenosis , Heart Valve Prosthesis Implantation , Wearable Electronic Devices , Aged , Aortic Valve Stenosis/surgery , Feasibility Studies , Humans , Patient Reported Outcome Measures , Risk Factors , Treatment Outcome
6.
Am Heart J ; 241: 14-25, 2021 11.
Article in English | MEDLINE | ID: covidwho-1283847

ABSTRACT

BACKGROUND: The COVID-19 pandemic has disrupted routine cardiovascular care, with unclear impact on procedural deferrals and associated outcomes across diverse patient populations. METHODS: Cardiovascular procedures performed at 30 hospitals across 6 Western states in 2 large, non-profit healthcare systems (Providence St. Joseph Health and Stanford Healthcare) from December 2018-June 2020 were analyzed for changes over time. Risk-adjusted in-hospital mortality was compared across pandemic phases with multivariate logistic regression. RESULTS: Among 36,125 procedures (69% percutaneous coronary intervention, 13% coronary artery bypass graft surgery, 10% transcatheter aortic valve replacement, and 8% surgical aortic valve replacement), weekly volumes changed in 2 distinct phases after the initial inflection point on February 23, 2020: an initial period of significant deferral (COVID I: March 15-April 11) followed by recovery (COVID II: April 12 onwards). Compared to pre-COVID, COVID I patients were less likely to be female (P = .0003), older (P < .0001), Asian or Black (P = .02), or Medicare insured (P < .0001), and COVID I procedures were higher acuity (P < .0001), but not higher complexity. In COVID II, there was a trend toward more procedural deferral in regions with a higher COVID-19 burden (P = .05). Compared to pre-COVID, there were no differences in risk-adjusted in-hospital mortality during both COVID phases. CONCLUSIONS: Significant decreases in cardiovascular procedural volumes occurred early in the COVID-19 pandemic, with disproportionate impacts by race, gender, and age. These findings should inform our approach to future healthcare disruptions.


Subject(s)
Aortic Valve Disease/surgery , COVID-19/epidemiology , Coronary Artery Bypass/statistics & numerical data , Coronary Artery Disease/surgery , Hospital Mortality , Percutaneous Coronary Intervention/statistics & numerical data , Time-to-Treatment/statistics & numerical data , Transcatheter Aortic Valve Replacement/statistics & numerical data , African Americans , Aged , Asian Americans , Female , Heart Valve Prosthesis Implantation/statistics & numerical data , Humans , Logistic Models , Male , Medicare , Middle Aged , SARS-CoV-2 , Sex Factors , United States/epidemiology
7.
Cardiol Young ; 31(12): 2045-2047, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1258530

ABSTRACT

Pulmonary valve endocarditis after transcatheter pulmonary valve implantation has been an emerging concern due to the increasing prevalence of transcatheter placement of pulmonary valve in the treatment of residual right ventricular outflow tract stenosis or regurgitation. Pulmonary valve endocarditis is a dreadful complication of transcatheter pulmonary valve implantation that have been reported with Melody valve (Medtronic, Inc., Minneapolis, MN) and Edward Sapien valve (Edwards Life Sciences, Irvine, CA) till date. There are scanty available literatures for pulmonary valve endocarditis with Venus P valve (Venus Medtech, Hangzhou, China) implantation. Furthermore, cardiovascular comorbidity is common in COVID-19 infection with limited evidence of COVID-19 infection concomitant with infective endocarditis. This case happens to be the first reported case of infective endocarditis of pulmonary valve with concomitant COVID-19 infection and also delayed presentation of pulmonary valve endocarditis with Venus P valve implantation.


Subject(s)
COVID-19 , Endocarditis , Heart Valve Prosthesis Implantation , Heart Valve Prosthesis , Pulmonary Valve Insufficiency , Pulmonary Valve , Cardiac Catheterization , Endocarditis/diagnosis , Endocarditis/etiology , Endocarditis/surgery , Heart Valve Prosthesis/adverse effects , Heart Valve Prosthesis Implantation/adverse effects , Humans , Prosthesis Design , Pulmonary Valve/diagnostic imaging , Pulmonary Valve/surgery , Pulmonary Valve Insufficiency/etiology , Pulmonary Valve Insufficiency/surgery , SARS-CoV-2 , Treatment Outcome
8.
Open Heart ; 8(1)2021 04.
Article in English | MEDLINE | ID: covidwho-1195855

ABSTRACT

BACKGROUND: The response to COVID-19 has required cancellation of all but the most urgent procedures; there is therefore a need for the reintroduction of a safe elective pathway. METHODS: This was a study of a pilot pathway performed at Barts Heart Centre for the admission of patients requiring elective coronary and structural procedures during the COVID-19 pandemic (April-June 2020). All patients on coronary and structural waiting lists were screened for procedural indications, urgency and adverse features for COVID-19 prognosis and discussed at dedicated multidisciplinary teams. Dedicated admission pathways involving preadmission isolation, additional consent, COVID-19 PCR testing and dedicated clean areas were used. RESULTS: 143 patients (101 coronary and 42 structural) underwent procedures (coronary angiography, percutaneous coronary intervention, transcatheter aortic valve intervention and MitralClip) during the study period. The average age was 68.2; 74% were male; and over 93% had one or more moderate COVID-19 risk factors. All patients were COVID-19 PCR negative on admission with (8.1%) COVID-19 antibody positive (swab negative). All procedures were performed successfully with low rates of procedural complications (9.8%). At 2-week follow-up, no patients had symptoms or confirmed COVID-19 infection with significant improvements in quality if life and symptoms. CONCLUSION: We demonstrated that patients undergoing coronary and structural procedures can be safely admitted during the COVID-19 pandemic, with no patients contracting COVID-19 during their admission. Reassuringly, patients reflective of typical practice, that is, those at moderate or higher risk, were treated successfully. This pilot provides important information applicable to other settings, specialties and areas to reintroduce services safely.


Subject(s)
COVID-19 , Cardiology Service, Hospital/organization & administration , Coronary Angiography/methods , Elective Surgical Procedures , Heart Valve Prosthesis Implantation/methods , Infection Control , Percutaneous Coronary Intervention/methods , Aged , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Testing , Elective Surgical Procedures/methods , Elective Surgical Procedures/statistics & numerical data , Elective Surgical Procedures/trends , Female , Humans , Infection Control/methods , Infection Control/organization & administration , Male , Organizational Innovation , Outcome and Process Assessment, Health Care , Risk Adjustment/methods , SARS-CoV-2 , Safety Management/organization & administration , United Kingdom/epidemiology
10.
Catheter Cardiovasc Interv ; 98(3): E478-E482, 2021 09.
Article in English | MEDLINE | ID: covidwho-1074302

ABSTRACT

The COVID-19 pandemic has resulted in the cancellation of many elective surgical procedures. This has led to reports of an increase in mortality for patients with non-Covid health conditions due to delayed definitive management. Patients with severe aortic stenosis have a high annual mortality if left untreated. These patients are at risk due to the reduced number of surgical aortic valve replacements and competition for intensive care facilities during the COVID-19 pandemic. This case series suggests that the minimally invasive transcatheter aortic valve implantation is safe to continue during the COVID-19 pandemic with adjustments to the patient pathway to minimize hospital stay and to reduce patient and staff exposure. This helps to reduce the delay of definitive treatment for patients with severe aortic stenosis.


Subject(s)
Aortic Valve Stenosis , COVID-19 , Heart Valve Prosthesis Implantation , Transcatheter Aortic Valve Replacement , Aortic Valve Stenosis/diagnostic imaging , Aortic Valve Stenosis/surgery , Heart Valve Prosthesis Implantation/adverse effects , Humans , Pandemics , Risk Factors , SARS-CoV-2 , Transcatheter Aortic Valve Replacement/adverse effects , Treatment Outcome
11.
BMJ Case Rep ; 14(1)2021 Jan 18.
Article in English | MEDLINE | ID: covidwho-1066840

ABSTRACT

The ongoing SARS-CoV-2 (COVID-19) pandemic has presented many difficult and unique challenges to the medical community. We describe a case of a middle-aged COVID-19-positive man who presented with pulmonary oedema and acute respiratory failure. He was initially diagnosed with acute respiratory distress syndrome. Later in the hospital course, his pulmonary oedema and respiratory failure worsened as result of severe acute mitral valve regurgitation secondary to direct valvular damage from COVID-19 infection. The patient underwent emergent surgical mitral valve replacement. Pathological evaluation of the damaged valve was confirmed to be secondary to COVID-19 infection. The histopathological findings were consistent with prior cardiopulmonary autopsy sections of patients with COVID-19 described in the literature as well as proposed theories regarding ACE2 receptor activity. This case highlights the potential of SARS-CoV-2 causing direct mitral valve damage resulting in severe mitral valve insufficiency with subsequent pulmonary oedema and respiratory failure.


Subject(s)
COVID-19/complications , Mitral Valve Insufficiency/etiology , Acute Disease , Atrial Fibrillation/complications , Atrial Fibrillation/physiopathology , COVID-19/therapy , Chordae Tendineae/diagnostic imaging , Echocardiography , Electrocardiography , Heart Valve Prosthesis Implantation , Humans , Male , Middle Aged , Mitral Valve Insufficiency/diagnostic imaging , Mitral Valve Insufficiency/physiopathology , Mitral Valve Insufficiency/surgery , Pulmonary Edema/etiology , Pulmonary Edema/physiopathology , Pulmonary Edema/therapy , Respiratory Insufficiency/etiology , Respiratory Insufficiency/physiopathology , Respiratory Insufficiency/therapy , SARS-CoV-2 , Severity of Illness Index , Shock, Cardiogenic/etiology , Shock, Cardiogenic/physiopathology
13.
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
14.
Eur J Clin Invest ; 51(5): e13463, 2021 May.
Article in English | MEDLINE | ID: covidwho-949358

ABSTRACT

AIMS: Obesity, diabetes and cardiovascular disease are associated with COVID-19 risk and severity. Because epicardial adipose tissue (EAT) expresses ACE2, we wanted to identify the main factors associated with ACE2 levels and its cleavage enzyme, ADAM17, in epicardial fat. MATERIALS AND METHODS: Epicardial and subcutaneous fat biopsies were obtained from 43 patients who underwent open-heart surgery. From 36 patients, biopsies were used for RNA expression analysis by real-time PCR of ACE1, ACE2 and ADAM17. From 8 patients, stromal vascular cells were submitted to adipogenesis or used for studying the treatment effects on gene expression levels. Soluble ACE2 was determined in supernatants by ELISA. RESULTS: Epicardial fat biopsies expressed higher levels of ACE2 (1.53 [1.49-1.61] vs 1.51 [1.47-1.56] a.u., P < .05) and lower ADAM17 than subcutaneous fat (1.67 [1.65-1.70] vs 1.70 [1.66-1.74] a.u., P < .001). Both genes were increased in epicardial fat from patients with type 2 diabetes mellitus (T2DM) (1.62 [1.50-2.28] vs 1.52 [1.49-1.55] a.u., P = .05 for ACE2 and 1.68 [1.66-1.78] vs 1.66 [1.63-1.69] a.u., P < .05 for ADAM17). Logistic regression analysis determined that T2DM was the main associated factor with epicardial ACE2 levels (P < .01). The highest ACE2 levels were found on patients with diabetes and obesity. ACE1 and ACE2 levels were not upregulated by antidiabetic treatment (metformin, insulin or thiazolidinedione). Its cellular levels, which were higher in epicardial than in subcutaneous stromal cells (1.61 [1.55-1.63] vs 1 [1-1.34]), were not correlated with the soluble ACE2. CONCLUSION: Epicardial fat cells expressed higher levels of ACE2 in comparison with subcutaneous fat cells, which is enhanced by diabetes and obesity presence in patients with cardiovascular disease. Both might be risk factors for SARS-CoV-2 infection.


Subject(s)
ADAM17 Protein/genetics , Angiotensin-Converting Enzyme 2/genetics , Diabetes Mellitus, Type 2/genetics , Obesity/genetics , Pericardium/metabolism , Stromal Cells/metabolism , Subcutaneous Fat/metabolism , Adipogenesis/genetics , Adipose Tissue/cytology , Adipose Tissue/metabolism , Aged , Aged, 80 and over , COVID-19 , Cardiac Surgical Procedures , Coronary Artery Bypass , Female , Heart Valve Prosthesis Implantation , Humans , Hypoglycemic Agents/therapeutic use , Insulin/therapeutic use , Logistic Models , Male , Metformin/therapeutic use , Middle Aged , Peptidyl-Dipeptidase A , Pericardium/cytology , RNA, Messenger/metabolism , Receptors, Coronavirus/genetics , Reverse Transcriptase Polymerase Chain Reaction , SARS-CoV-2/metabolism , Subcutaneous Fat/cytology , Thiazolidinediones/therapeutic use
16.
Interact Cardiovasc Thorac Surg ; 31(6): 904-905, 2020 12 07.
Article in English | MEDLINE | ID: covidwho-894595

ABSTRACT

We present a case report of fatal respiratory failure after cardiac surgery in the early stages of the coronavirus disease 2019 outbreak. Although not supported by epidemiological data nor clinical course, coronavirus disease 2019 infection was revealed post-mortem by immunohistochemical detection of the severe acute respiratory syndrome coronavirus 2 spike protein in lung tissue.


Subject(s)
Aortic Valve Stenosis/surgery , COVID-19/epidemiology , Heart Valve Prosthesis Implantation/adverse effects , SARS-CoV-2 , Aged , Aortic Valve Stenosis/epidemiology , Comorbidity , Fatal Outcome , Female , Humans
17.
Eur J Clin Invest ; 51(1): e13436, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-880897

ABSTRACT

BACKGROUND: The coronavirus disease 2019 (COVID-19) shows high morbidity and mortality, particularly in patients with concomitant cardiovascular diseases. Some of these patients are under oral anticoagulation (OAC) at admission, but to date, there are no data on the clinical profile, prognosis and risk factors of such patients during hospitalization for COVID-19. DESIGN: Subanalysis of the international 'real-world' HOPE COVID-19 registry. All patients with prior OAC at hospital admission for COVID-19 were suitable for the study. All-cause mortality was the primary endpoint. RESULTS: From 1002 patients included, 110 (60.9% male, median age of 81.5 [IQR 75-87] years, median Short-Form Charlson Comorbidity Index [CCI] of 1 [IQR 1-3]) were on OAC at admission, mainly for atrial fibrillation and venous thromboembolism. After propensity score matching, 67.9% of these patients died during hospitalization, which translated into a significantly higher mortality risk compared to patients without prior OAC (HR 1.53, 95% CI 1.08-2.16). After multivariate Cox regression analysis, respiratory insufficiency during hospitalization (HR 6.02, 95% CI 2.18-16.62), systemic inflammatory response syndrome (SIRS) during hospitalization (HR 2.29, 95% CI 1.34-3.91) and the Short-Form CCI (HR 1.24, 95% CI 1.03-1.49) were the main risk factors for mortality in patients on prior OAC. CONCLUSIONS: Compared to patients without prior OAC, COVID-19 patients on OAC therapy at hospital admission showed lower survival and higher mortality risk. In these patients on OAC therapy, the prevalence of several comorbidities is high. Respiratory insufficiency and SIRS during hospitalization, as well as higher comorbidity, pointed out those anticoagulated patients with increased mortality risk.


Subject(s)
Anticoagulants/therapeutic use , Atrial Fibrillation/drug therapy , COVID-19/mortality , Hospital Mortality , Thromboembolism/epidemiology , Venous Thromboembolism/drug therapy , Aged , Aged, 80 and over , Atrial Fibrillation/epidemiology , Comorbidity , Factor Xa Inhibitors/therapeutic use , Female , Heart Failure/epidemiology , Heart Valve Prosthesis , Heart Valve Prosthesis Implantation , Heparin/therapeutic use , Heparin, Low-Molecular-Weight/therapeutic use , Humans , Intensive Care Units , Male , Multivariate Analysis , Prognosis , Propensity Score , Proportional Hazards Models , Renal Insufficiency/epidemiology , Respiration, Artificial , Respiratory Insufficiency/epidemiology , Risk Factors , SARS-CoV-2 , Sepsis/epidemiology , Systemic Inflammatory Response Syndrome/epidemiology , Venous Thromboembolism/epidemiology
18.
Cardiol Young ; 30(9): 1358-1359, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-851194

ABSTRACT

A 16-year-old girl with history of treated congenital mitral valve disease and signs of respiratory infection was admitted to our paediatric cardiology department. She was tested positive for severe acute respiratory syndrome coronavirus 2. Despite her severe pre-existing cardiac conditions with pulmonary hypertension, atrial arrhythmias and mitral valve stenosis, the infection did not lead to any cardiac or pulmonary deterioration. In adults, cardiac co-morbidities are known risk factors for a severe course of coronavirus disease 2019 infections. This case illustrates that in children even severe cardiac disease is not necessarily associated with a severe course of coronavirus disease 2019.


Subject(s)
Coronavirus Infections , Heart Atria , Heart Valve Prosthesis Implantation , Mitral Valve Insufficiency , Mitral Valve Stenosis , Pandemics , Pneumonia, Viral , Prosthesis Failure/adverse effects , Adolescent , Betacoronavirus/isolation & purification , COVID-19 , Coronavirus Infections/complications , Coronavirus Infections/diagnosis , Coronavirus Infections/drug therapy , Coronavirus Infections/physiopathology , Coronavirus Infections/therapy , Echocardiography/methods , Female , Heart Atria/diagnostic imaging , Heart Atria/pathology , Heart Valve Prosthesis Implantation/adverse effects , Heart Valve Prosthesis Implantation/methods , Humans , Hypertension, Pulmonary/diagnosis , Hypertension, Pulmonary/etiology , Hypertension, Pulmonary/physiopathology , Mitral Valve/pathology , Mitral Valve/physiopathology , Mitral Valve/surgery , Mitral Valve Insufficiency/complications , Mitral Valve Insufficiency/congenital , Mitral Valve Insufficiency/surgery , Mitral Valve Stenosis/complications , Mitral Valve Stenosis/congenital , Mitral Valve Stenosis/surgery , Organ Size , Pneumonia, Viral/complications , Pneumonia, Viral/diagnosis , Pneumonia, Viral/physiopathology , Pneumonia, Viral/therapy , SARS-CoV-2 , Treatment Outcome
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