Transcatheter Aortic Valve Implantation Amid the COVID-19 Pandemic: A nationwide Analysis of the First COVID-19 Wave in the Netherlands

Overview

Journal Neth Heart J

Specialty Cardiology & Vascular Diseases

Date 2022 Jun 1

PMID 35648264

Authors

M J P Rooijakkers

W W L Li

N A Stens

M M Vis

P A L Tonino

L Timmers

N M Van Mieghem

P den Heijer

S Kats

P R Stella

V Roolvink

H W van der Werf

M G Stoel

C E Schotborgh

G Amoroso

F Porta

F Van der Kley

M H van Wely

H Gehlmann

L A F M van Garsse

G S C Geuzebroek

M W A Verkroost

J M Mourisse

N M Medendorp

N van Royen

Affiliations

Soon will be listed here.

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.

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References

Soreide K, Hallet J, Matthews J, Schnitzbauer A, Line P, Lai P . Immediate and long-term impact of the COVID-19 pandemic on delivery of surgical services. Br J Surg. 2020; 107(10):1250-1261. PMC: 7267363. DOI: 10.1002/bjs.11670. View

Gaudino M, Chikwe J, Hameed I, Robinson N, Fremes S, Ruel M . Response of Cardiac Surgery Units to COVID-19: An Internationally-Based Quantitative Survey. Circulation. 2020; 142(3):300-302. PMC: 7365675. DOI: 10.1161/CIRCULATIONAHA.120.047865. View

Kapadia S, Leon M, Makkar R, Tuzcu E, Svensson L, Kodali S . 5-year outcomes of transcatheter aortic valve replacement compared with standard treatment for patients with inoperable aortic stenosis (PARTNER 1): a randomised controlled trial. Lancet. 2015; 385(9986):2485-91. DOI: 10.1016/S0140-6736(15)60290-2. View

Malaisrie S, McDonald E, Kruse J, Li Z, McGee Jr E, Abicht T . Mortality while waiting for aortic valve replacement. Ann Thorac Surg. 2014; 98(5):1564-70. DOI: 10.1016/j.athoracsur.2014.06.040. View

Martin G, Curzen N, Goodwin A, Nolan J, Balacumaraswami L, Ludman P . Indirect Impact of the COVID-19 Pandemic on Activity and Outcomes of Transcatheter and Surgical Treatment of Aortic Stenosis in England. Circ Cardiovasc Interv. 2021; 14(5):e010413. PMC: 8126473. DOI: 10.1161/CIRCINTERVENTIONS.120.010413. View

Tay E, Hayashida K, Chen M, Yin W, Park D, Seth A . Transcatheter aortic valve implantation during the COVID-19 pandemic: Clinical expert opinion and consensus statement for Asia. J Card Surg. 2020; 35(9):2142-2146. DOI: 10.1111/jocs.14722. View

Shah P, Welt F, Mahmud E, Phillips A, Kleiman N, Young M . Triage Considerations for Patients Referred for Structural Heart Disease Intervention During the COVID-19 Pandemic: An ACC/SCAI Position Statement. JACC Cardiovasc Interv. 2020; 13(12):1484-1488. PMC: 7270905. DOI: 10.1016/j.jcin.2020.04.001. View

Tanguturi V, Lindman B, Pibarot P, Passeri J, Kapadia S, Mack M . Managing Severe Aortic Stenosis in the COVID-19 Era. JACC Cardiovasc Interv. 2020; 13(16):1937-1944. PMC: 7263810. DOI: 10.1016/j.jcin.2020.05.045. View

Lauck S, Forman J, Borregaard B, Sathananthan J, Achtem L, McCalmont G . Facilitating transcatheter aortic valve implantation in the era of COVID-19: Recommendations for programmes. Eur J Cardiovasc Nurs. 2020; 19(6):537-544. PMC: 7717283. DOI: 10.1177/1474515120934057. View

10.

Rooijakkers M, Li W, Wollersheim L, Geuzebroek G, Gehlmann H, van Garsse L . Transcatheter aortic valve replacement during the COVID-19 pandemic-A Dutch single-center analysis. J Card Surg. 2020; 36(1):48-55. PMC: 7821107. DOI: 10.1111/jocs.15123. View

11.

Vendrik J, de Boer J, Zwiers W, van Gilst S, Holierook M, Chekanova E . Ongoing transcatheter aortic valve implantation (TAVI) practice amidst a global COVID-19 crisis: nurse-led analgesia for transfemoral TAVI. Neth Heart J. 2020; 28(7-8):384-386. PMC: 7357262. DOI: 10.1007/s12471-020-01472-4. View

12.

Genereux P, Piazza N, Alu M, Nazif T, Hahn R, Pibarot P . Valve Academic Research Consortium 3: updated endpoint definitions for aortic valve clinical research. Eur Heart J. 2021; 42(19):1825-1857. DOI: 10.1093/eurheartj/ehaa799. View

13.

Adlam D, Chan N, Baron J, Kovac J . Aortic stenosis in the time of COVID-19: Development and outcomes of a rapid turnaround TAVI service. Catheter Cardiovasc Interv. 2021; 98(3):E478-E482. PMC: 8014719. DOI: 10.1002/ccd.29550. View

14.

Valdebenito M, Massalha E, Barbash I, Maor E, Fefer P, Guetta V . Transcatheter Aortic Valve Implantation During the COVID-19 Pandemic. Am J Cardiol. 2021; 145:97-101. PMC: 7836376. DOI: 10.1016/j.amjcard.2020.12.086. View

15.

Thiele H, Kurz T, Feistritzer H, Stachel G, Hartung P, Lurz P . General Versus Local Anesthesia With Conscious Sedation in Transcatheter Aortic Valve Implantation: The Randomized SOLVE-TAVI Trial. Circulation. 2020; 142(15):1437-1447. DOI: 10.1161/CIRCULATIONAHA.120.046451. View

16.

Feistritzer H, Kurz T, Stachel G, Hartung P, Lurz P, Eitel I . Impact of Anesthesia Strategy and Valve Type on Clinical Outcomes After Transcatheter Aortic Valve Replacement. J Am Coll Cardiol. 2021; 77(17):2204-2215. DOI: 10.1016/j.jacc.2021.03.007. View

17.

Perdoncin E, Greenbaum A, Grubb K, Babaliaros V, Keegan P, Ceretto-Clark B . Safety of same-day discharge after uncomplicated, minimalist transcatheter aortic valve replacement in the COVID-19 era. Catheter Cardiovasc Interv. 2020; 97(5):940-947. DOI: 10.1002/ccd.29453. View

18.

Denimal T, Delhaye C, Pierache A, Robin E, Modine T, Moussa M . Feasibility and safety of transfemoral transcatheter aortic valve implantation performed with a percutaneous coronary intervention-like approach. Arch Cardiovasc Dis. 2021; 114(8-9):537-549. DOI: 10.1016/j.acvd.2020.12.007. View