Transcatheter aortic valve implantation amid the COVID-19 pandemic: a nationwide analysis of the first COVID-19 wave in the Netherlands

Abstract

Introduction The coronavirus disease 2019 (COVID-19) pandemic has put tremendous pressure on healthcare systems. Most transcatheter aortic valve implantation (TAVI) centres have adopted different triage systems and procedural strategies to serve highest-risk patients first and to minimise the burden on hospital logistics and personnel. We therefore assessed the impact of the COVID-19 pandemic on patient selection, type of anaesthesia and outcomes after TAVI. Methods We used data from the Netherlands Heart Registration to examine all patients who underwent TAVI between March 2020 and July 2020 (COVID cohort), and between March 2019 and July 2019 (pre-COVID cohort). We compared patient characteristics, procedural characteristics and clinical outcomes. Results We examined 2131 patients who underwent TAVI (1020 patients in COVID cohort, 1111 patients in pre-COVID cohort). EuroSCORE II was comparable between cohorts (COVID 4.5 ± 4.0 vs pre-COVID 4.6 ± 4.2, p = 0.356). The number of TAVI procedures under general anaesthesia was lower in the COVID cohort (35.2% vs 46.5%, p < 0.001). Incidences of stroke (COVID 2.7% vs pre-COVID 1.7%, p = 0.134), major vascular complications (2.3% vs 3.4%, p = 0.170) and permanent pacemaker implantation (10.0% vs 9.4%, p = 0.634) did not differ between cohorts. Thirty-day and 150-day mortality were comparable (2.8% vs 2.2%, p = 0.359 and 5.2% vs 5.2%, p = 0.993, respectively). Conclusions During the COVID-19 pandemic, patient characteristics and outcomes after TAVI were not different than before the pandemic. This highlights the fact that TAVI procedures can be safely performed during the COVID-19 pandemic, without an increased risk of complications or mortality.

Impact of the COVID‐19 pandemic on provision of interventional cardiology and cardiac surgery services in Australia: a review of Medicare claims data

“…23 However, data on the outcomes of the patients undergoing TAVI during the COVID-19 pandemic in Australia are not available; studies of patients undergoing TAVI during the COVID-19 pandemic period in the United Kingdom and the Netherlands found no excess complications, time delays, mortality or in-hospital COVID-19 acquisition. 24,25 Moreover, the COVID-19 pandemic has led to the expedited advent of same-day discharge protocols for patients undergoing TAVI internationally, with demonstrable safety and feasibility in highly selected patients. 26 Overall, the COVID-19 pandemic has seen an increased uptake of TAVI in Australia, despite reductions in other interventional cardiology and cardiac surgery procedures.…”

“…TAVI is minimally invasive and is associated with shorter duration of hospital stay and decreased intensive care unit requirement when compared to surgical aortic valve replacement; these factors render it a favourable option for the management of often highly comorbid patients with severe AS who are at increased risk of adverse outcomes from COVID‐19 23 . However, data on the outcomes of the patients undergoing TAVI during the COVID‐19 pandemic in Australia are not available; studies of patients undergoing TAVI during the COVID‐19 pandemic period in the United Kingdom and the Netherlands found no excess complications, time delays, mortality or in‐hospital COVID‐19 acquisition 24,25 . Moreover, the COVID‐19 pandemic has led to the expedited advent of same‐day discharge protocols for patients undergoing TAVI internationally, with demonstrable safety and feasibility in highly selected patients 26 .…”

National Trends of Structural Heart Disease Interventions from 2016 to 2020 in the United States and the Associated Impact of COVID-19 Pandemic

“…Further, we observed no differences in the in-hospital mortality outcome and acute stroke, that was similar to studies that showed that TAVR can be safely performed during the COVID-19 pandemic, without an increased risk of complications or mortality. A study from Netherlands examined 2,131 patients before and during the COVID-19 pandemic and found that the patient characteristics and outcomes after TAVR were not different during the pandemic 12 . A single-center study in Israel compared TAVR outcomes among 270 patients before and during the COVID-19 pandemic and showed that the primary outcome revealed similar TAVR success 13 .…”

Dealing with a new disease

“…In this issue of the Netherlands Heart Journal , a number of papers describe the cardiovascular impact of the coronavirus disease 2019 (COVID-19) pandemic [ 1 , 2 ]. These studies highlight how this novel disease triggers an impressive worldwide response by both healthcare workers and scientists.…”