Mortality, Stroke, and Hospitalization Associated With Deferred vs Expedited Aortic Valve Replacement in Patients Referred for Symptomatic Severe Aortic Stenosis During the COVID-19 Pandemic

Ryffel, Christoph; Lanz, Jonas; Corpataux, Noé; Reusser, Nicole; Stortecky, Stefan; Windecker, Stephan; Pilgrim, Thomas

doi:10.1001/jamanetworkopen.2020.20402

Cited by 24 publications

(20 citation statements)

References 3 publications

(4 reference statements)

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“…This study was not designed to evaluate the clinical management of aortic stenosis during the ongoing COVID-19 pandemic. However, recent research suggests that patients with aortic stenosis should not currently undergo TAVR unless in the presence of severe disease [ 31 , 32 , 33 ]. Such an approach may serve to reduce potential exposure to SARS-CoV-2 during hospitalization.…”

Section: Discussionmentioning

confidence: 99%

Risk and Severity of COVID-19 and ABO Blood Group in Transcatheter Aortic Valve Patients

Kibler

Dietrich

Kanso

et al. 2020

JCM

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While cardiovascular disease has been associated with an increased risk of coronavirus disease 2019 (COVID-19), no studies have described its clinical course in patients with aortic stenosis who had undergone transcatheter aortic valve replacement (TAVR). Numerous observational studies have reported an association between the A blood group and an increased susceptibility to SARS-CoV-2 infection. Our objective was to investigate the frequency and clinical course of COVID-19 in a large sample of patients who had undergone TAVR and to determine the associations of the ABO blood group with disease occurrence and outcomes. Patients who had undergone TAVR between 2010 and 2019 were included in this study and followed-up through the recent COVID-19 outbreak. The occurrence and severity (hospitalization and/or death) of COVID-19 and their associations with the ABO blood group served as the main outcome measures. Of the 1125 patients who had undergone TAVR, 403 (36%) died before 1 January 2020, and 20 (1.8%) were lost to follow-up. The study sample therefore consisted of 702 patients. Of them, we identified 22 cases (3.1%) with COVID-19. Fourteen patients (63.6%) were hospitalized or died of disease. Multivariable analysis identified the A blood group (vs. others) as the only independent predictor of COVID-19 in patients who had undergone TAVR (odds ratio (OR) = 6.32; 95% confidence interval (CI) = 2.11−18.92; p = 0.001). The A blood group (vs. others; OR = 8.27; 95% CI = 1.83−37.43, p = 0.006) and a history of cancer (OR = 4.99; 95% CI = 1.64−15.27, p = 0.005) were significantly and independently associated with disease severity (hospitalization and/or death). We conclude that patients who have undergone TAVR frequently have a number of cardiovascular comorbidities that may work to increase the risk of COVID-19. The subgroup with the A blood group was especially prone to developing the disease and showed unfavorable outcomes.

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Section: Discussionmentioning

confidence: 99%

Risk and Severity of COVID-19 and ABO Blood Group in Transcatheter Aortic Valve Patients

Kibler

Dietrich

Kanso

et al. 2020

JCM

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“…In two U.S. studies, this led to high levels of mortality in patients awaiting aortic valve interventions. 6 , 7 Guidance from the European Society of Cardiology and the European Association of Percutaneous Cardiovascular Interventions (EAPCI) has attempted to align patient needs with requirements for safety of both patients and caregivers, and address many of the uncertainties about who should be treated, how and with what urgency 2 , 3 ; this was backed up in Europe by industry-supported unbranded initiatives to encourage patients not to delay or avoid medical contact when they suffered symptoms suggestive of myocardial infarction or critical limb ischaemia.…”

Section: Adaptationmentioning

confidence: 99%

Impact of the COVID-19 pandemic: a perspective from industry

West

Cheong

Boone

et al. 2020

European Heart Journal Supplements

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The global COVID-19 pandemic has led to unprecedented change throughout society.1 As the articles in this supplement outline, all segments of the broader cardiovascular community have been forced to adapt, to change models of care delivery, and to evolve and innovate in order to deliver optimal management for cardiovascular patients. The medtech/device industry has not been exempt from such change and has been forced to navigate direct and indirect COVID-associated disruption, with effects felt from supply chain logistics to the entire product lifecycle, from the running of clinical trials to new device approvals and managing training, proctoring and congresses in an increasingly-online world. This sea-change in circumstances itself has enforced the industry, in effect, to disrupt its own processes, models and activities. Whilst some of these changes may be temporary, many will endure for some time and some will doubtless become permanent; one thing is for sure: the healthcare ecosystem, including the medical device industry, will never look quite the same again. Although the pandemic has brought a short- to medium-term medical crisis to many countries, its role as a powerful disruptor cannot be underestimated, and may indeed prove to be a force for long-term good, given the accelerated innovation and rapid adaptation that it has cultivated.

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“…A triage algorithm was prospectively implemented to allocate patients with symptomatic severe aortic stenosis to expedited versus deferred aortic valve replacement (AVR). A preliminary evaluation of our algorithm has been reported previously and focused on clinical events during the wait time for AVR in the deferred treatment arm [ 2 ]. Here, we report the pre-specified primary endpoint results at six months.…”

mentioning

confidence: 99%

“…Patients with stable symptoms were scheduled for deferred AVR. Instruments of data collection and follow-up have been detailed previously [ 2 ]. The primary endpoint was a composite of all-cause mortality, stroke, and hospitalization for heart failure by intention-to-treat as assessed at six months.…”

mentioning

confidence: 99%

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Deferred versus Expedited Aortic Valve Replacement in Patients with Symptomatic Severe Aortic Stenosis During the SARS-CoV-2 Pandemic (AS DEFER): A Research Letter

et al. 2021

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Mortality, Stroke, and Hospitalization Associated With Deferred vs Expedited Aortic Valve Replacement in Patients Referred for Symptomatic Severe Aortic Stenosis During the COVID-19 Pandemic

Cited by 24 publications

References 3 publications

Risk and Severity of COVID-19 and ABO Blood Group in Transcatheter Aortic Valve Patients

Risk and Severity of COVID-19 and ABO Blood Group in Transcatheter Aortic Valve Patients

Impact of the COVID-19 pandemic: a perspective from industry

Deferred versus Expedited Aortic Valve Replacement in Patients with Symptomatic Severe Aortic Stenosis During the SARS-CoV-2 Pandemic (AS DEFER): A Research Letter

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