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Safety and Operational Efficiency of Restructuring and Redeploying a Transcatheter Aortic Valve Replacement Service During the COVID-19 Pandemic: The Oxford Experience.
Joseph, Jubin; Kotronias, Rafail A; Estrin-Serlui, Theodore; Cahill, Thomas J; Kharbanda, Rajesh K; Newton, James D; Grebenik, Catherine; Dawkins, Sam; Banning, Adrian P.
  • Joseph J; Oxford Heart Center, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
  • Kotronias RA; Oxford Heart Center, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; Department of Cardiovascular Medicine, University of Oxford, Oxford, UK.
  • Estrin-Serlui T; Oxford Heart Center, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
  • Cahill TJ; Oxford Heart Center, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
  • Kharbanda RK; Oxford Heart Center, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
  • Newton JD; Oxford Heart Center, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
  • Grebenik C; Oxford Heart Center, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
  • Dawkins S; Oxford Heart Center, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
  • Banning AP; Oxford Heart Center, Oxford University Hospitals NHS Foundation Trust, Oxford, UK. Electronic address: Adrian.Banning@ouh.nhs.uk.
Cardiovasc Revasc Med ; 31: 26-31, 2021 10.
Article in English | MEDLINE | ID: covidwho-956955
Semantic information from SemMedBD (by NLM)
1. Aortic Valve Stenosis PROCESS_OF Patients
Subject
Aortic Valve Stenosis
Predicate
PROCESS_OF
Object
Patients
2. Aortic Valve Stenosis PROCESS_OF Patients
Subject
Aortic Valve Stenosis
Predicate
PROCESS_OF
Object
Patients
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.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Aortic Valve Stenosis / Heart Valve Prosthesis Implantation / Transcatheter Aortic Valve Replacement / COVID-19 Type of study: Etiology study / Observational study / Prognostic study / Risk factors Limits: Humans Language: English Journal: Cardiovasc Revasc Med Journal subject: Vascular Diseases / Cardiology Year: 2021 Document Type: Article Affiliation country: J.carrev.2020.12.002

Full text: Available Collection: International databases Database: MEDLINE Main subject: Aortic Valve Stenosis / Heart Valve Prosthesis Implantation / Transcatheter Aortic Valve Replacement / COVID-19 Type of study: Etiology study / Observational study / Prognostic study / Risk factors Limits: Humans Language: English Journal: Cardiovasc Revasc Med Journal subject: Vascular Diseases / Cardiology Year: 2021 Document Type: Article Affiliation country: J.carrev.2020.12.002