Structured Allocation of Transcatheter Aortic Valve Replacement Patients during Coronavirus Disease 2019 Pandemic:...

Area of Science:

• Cardiology
• Healthcare Management
• Public Health

Background:

• The Coronavirus Disease 2019 (COVID-19) pandemic led to medical resource shortages.
• Transcatheter Aortic Valve Replacement (TAVR) procedures require careful resource allocation.
• An allocation algorithm was implemented to manage TAVR during the pandemic.

Purpose of the Study:

• To investigate the impact of a TAVR allocation algorithm on patient selection.
• To evaluate procedural outcomes and hospital resource utilization post-algorithm implementation.
• To assess the safety and efficiency of TAVR during pandemic-related resource constraints.

Main Methods:

• Comparative analysis of 456 TAVR patients before (pre-COVID-19) and 456 patients after (COVID-19) algorithm implementation.
• Assessment of patient characteristics, including cardiac decompensations, angina severity, troponin levels, and left ventricular ejection fraction (LVEF).
• Evaluation of procedural characteristics (predilatations, procedural time) and hospital resource utilization (in-hospital stay, monthly patient volume).

Main Results:

• The COVID-19 group presented with sicker patients: higher rates of cardiac decompensations, severe angina, elevated troponin, and reduced LVEF.
• Procedural characteristics showed increased predilatations and longer procedural times in the COVID-19 group.
• Despite increased patient acuity, TAVR success rates remained high, with no difference in safety parameters. The COVID-19 group experienced shorter in-hospital stays and fewer patients treated monthly.

Conclusions:

• The TAVR allocation algorithm effectively prioritized sicker patients during the COVID-19 pandemic.
• The algorithm facilitated efficient and safe TAVR procedures, comparable to pre-pandemic outcomes.
• Implementation of the algorithm contributed to a reduction in in-hospital stay duration.