Transcatheter aortic valve replacement during the COVID‐19 pandemic—A Dutch single‐center analysis

Abstract

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.

Transcatheter aortic valve implantation during COVID-19 pandemic: An optimized model to relieve healthcare system overload

“…Our results are concordant with studies carried out in several countries (Israel, United Kingdom, Poland, Holland, France) that did not show significant differences in mortality and procedural outcomes between the pandemic and pre-pandemic periods, thus supporting the possibility to maintain safely the TAVI program by adopting adequate safety measures and pathway during pre, peri-and post-procedural cares [14][15][16][17].…”

Structural Heart Interventions During COVID-19

“…COVID-19 testing after TAVR (11%) resulted in 2 (3%) positive tests at 11 and 13 days post-procedure. 30 Both patients died due to COVID-19 at 14 and 16 days post-procedure.…”

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

“…Multiple position statements have been published on when to perform TAVI for symptomatic severe AS amid the COVID-19 crisis [ 6 – 9 ]. However, the risks of adverse events caused by postponement of these interventions should be balanced against the risks of contracting COVID-19 when hospitalised for this high-risk cardiovascular intervention [ 10 ]. Also, most TAVI centres have adopted different triage systems and different procedural strategies during the COVID-19 pandemic, aiming to serve highest-risk patients first and to minimise the burden on hospital logistics and personnel [ 11 ].…”

“…We previously reported on the safety and feasibility of a continued TAVI programme during the COVID-19 pandemic in our own centre [ 10 ]. Here we present data from the Netherlands Heart Registration (NHR), a nationwide registry in which data on all cardiac interventions performed in the Netherlands are collected.…”