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Transcatheter aortic valve replacement during the COVID-19 pandemic-A Dutch single-center analysis
Maxim J P Rooijakkers1, Wilson W L Li2, Laurens W L M Wollersheim2
1Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands.
Insights
Transcatheter aortic valve replacement (TAVR) is feasible during the COVID-19 pandemic, but patients face risks. Continued TAVR programs are possible, though COVID-19 related mortality is a concern.
Area of Science:
- Cardiology
- Interventional Cardiology
- Public Health
Background:
- The COVID-19 pandemic strained healthcare systems, leading to elective procedure suspensions like TAVR.
- Deferring TAVR for severe aortic stenosis risks significant wait-time mortality.
- No data existed on TAVR program safety during the COVID-19 crisis.
Purpose of the Study:
- To assess the safety and feasibility of continuing TAVR during the COVID-19 pandemic.
- To evaluate COVID-19 related outcomes in patients undergoing TAVR.
Main Methods:
- Retrospective evaluation of 71 patients who underwent TAVR between February 27, 2020, and June 30, 2020.
- Clinical outcomes assessed using Valve Academic Research Consortium 2 definitions.
- Patient follow-up via chart review and telephone surveys.
Main Results:
- Procedural success rate was 99% in 71 TAVR patients (median age 80, 63% male).
- 30% required ICU admission; 94% discharged same-day to cardiac care.
- Two patients (3%) contracted COVID-19 post-TAVR, both succumbing to pneumonia within two weeks.
Conclusions:
- Continuing TAVR programs during the COVID-19 pandemic is feasible, even with strained resources.
- COVID-19 infection post-TAVR poses a significant mortality risk.
- Careful patient selection and monitoring are crucial for TAVR during pandemics.
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.
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