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Ambulatory TAVR: Early Feasibility Experience During the COVID-19 Pandemic
Oualid Zouaghi1, Jérôme Wintzer-Wehekind1,2, Yves Lienhart1
1Cardiology Department, Médipole HP Lyon-Villeurbane, Villeurbane, France.
Insights
Ambulatory transcatheter aortic valve replacement (TAVR) is feasible for select aortic stenosis patients, even during the COVID-19 pandemic. This approach reduces treatment delays, minimizes infection risk, and conserves hospital resources.
Area of Science:
- Cardiology
- Interventional Cardiology
- Public Health
Background:
- The COVID-19 pandemic created challenges for managing patients with symptomatic aortic stenosis, potentially increasing mortality due to treatment delays.
- Elective procedures were often postponed, necessitating innovative approaches to care delivery.
Observation:
- A clinical case series involving 3 patients with symptomatic aortic stenosis who underwent ambulatory transcatheter aortic valve replacement (TAVR).
- Patient and caregiver willingness, meticulous patient selection (including those with prior permanent pacemaker placement), and a minimalist procedural strategy were key factors.
- The procedures were performed without any complications during the 30-day follow-up period.
Findings:
- Ambulatory TAVR was successfully performed in these selected patients, demonstrating the feasibility of outpatient management.
- The minimalist TAVR protocol enabled safe and effective treatment delivery outside the traditional hospital setting.
- No adverse events were reported within the 30-day follow-up, highlighting the safety of this approach.
Implications:
- Ambulatory TAVR can mitigate the adverse effects of prolonged wait times for aortic stenosis treatment.
- This model minimizes patient exposure to healthcare-associated coronavirus contamination.
- It also conserves vital hospital resources, which are crucial during public health crises like the COVID-19 pandemic.
- Outpatient management of aortic stenosis via minimalist TAVR offers a sustainable solution in pandemic conditions.
Abstract:
The COVID-19 pandemic has modified practice for patients with symptomatic aortic stenosis and could result in higher mortality rates due to treatment delays. In this clinical case series, 3 patients underwent ambulatory transcatheter aortic valve replacement (TAVR) thanks to patient and entourage willingness, careful patient selection (including a history of permanent pacemaker placement), and a minimalist procedural approach. No complications occurred during the 30-day follow-up. Performing ambulatory TAVR could reduce the clinical consequences of wait times, minimize exposure to coronavirus contamination, and reduce the use of hospital resources that might be needed for COVID-19 patients. Thanks to a scrupulous minimalist TAVR protocol, ambulatory outpatient management of aortic stenosis was possible in the context of the COVID-19 pandemic.
