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Transcatheter aortic valve implantation versus surgical aortic valve replacement during the COVID-19 pandemic-Current
Ahmed M A Shafi1, Wael I Awad1
1Department of Cardiothoracic Surgery, Bart's Heart Centre, St Bartholomew's Hospital, London, UK.
Insights
The COVID-19 pandemic impacted cardiac surgery, leading to increased use of transcatheter aortic valve implantation (TAVI). Long-term data for TAVI, especially in new patient groups, remains unknown, necessitating cautious decision-making.
Area of Science:
- Cardiology
- Healthcare Management
- Infectious Diseases
Background:
- COVID-19 significantly disrupted healthcare, particularly cardiac surgery.
- Patients with cardiovascular comorbidities faced higher risks from COVID-19.
- Reduced cardiac surgery provision led to exploring alternative treatments for aortic valve disease.
Purpose of the Study:
- To evaluate the impact of COVID-19 on cardiac surgery provision.
- To assess the role of transcatheter aortic valve implantation (TAVI) as an alternative to surgical aortic valve replacement.
- To identify concerns regarding the expanded use of TAVI in light of unknown long-term outcomes.
Main Methods:
- Review of healthcare provision changes during the COVID-19 pandemic.
- Analysis of TAVI's advantages over surgical aortic valve replacement in resource utilization.
- Examination of TAVI's application in younger, low-risk, and previously excluded patient populations.
Main Results:
- COVID-19 led to a significant reduction in cardiac surgery.
- Transcatheter aortic valve implantation (TAVI) emerged as a resource-efficient alternative for aortic valve disease.
- TAVI is increasingly considered for younger and lower-risk patients, but long-term data is lacking.
Conclusions:
- The COVID-19 pandemic accelerated the adoption of TAVI for aortic valve disease.
- Concerns exist regarding the long-term efficacy and safety of TAVI in patient groups not studied in pivotal trials.
- Careful consideration and further long-term data are essential for TAVI as a preferred treatment choice.
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.
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