Transcatheter aortic valve implantation during COVID-19 pandemic: An optimized model to relieve healthcare system overload.
COVID-19
Logistics
Optimization
Outcomes
TAVI
Journal
International journal of cardiology
ISSN: 1874-1754
Titre abrégé: Int J Cardiol
Pays: Netherlands
ID NLM: 8200291
Informations de publication
Date de publication:
01 04 2022
01 04 2022
Historique:
received:
24
11
2021
revised:
11
01
2022
accepted:
19
01
2022
pubmed:
26
1
2022
medline:
5
3
2022
entrez:
25
1
2022
Statut:
ppublish
Résumé
The coronavirus 2019 (COVID-19) pandemic upset healthcare systems and their logistics worldwide. We sought to assess safety and effectiveness of an optimized logistics for transcatheter aortic valve implantation (TAVI) pathway developed during the COVID-19 pandemic. This is a retrospective analysis. An optimized TAVI logistics based on performing TAVI work-up and procedure during the same hospitalization was used during the COVID-19 pandemic. In-hospital and 30-day outcomes of patients treated during the pandemic were compared with an historical cohort of patients undergoing TAVI with staged work-up before the pandemic within an homogeneous timeframe. Of 536 patients, 227 (42.4%) underwent TAVI during the COVID-19 pandemic with a reduction of 26.5% compared to the pre-pandemic period (n = 309). The median age was 81 (77-85) years and STS score was 3.4 (2.2-5.6)%. Lower rates of in-hospital major vascular complications (2.2% vs. 8.7%; p < 0.01) and life-threatening bleeding (0.4% vs. 4.2%; p = 0.01) were reported in the COVID-19 period, whereas no difference in acute kidney injury (7.0% vs. 7.4%, p = 0.85) rate was reported between COVID-19 and pre-COVID-19 periods. No difference in 30-day rates of all-cause death (4.0 vs. 4.5, p = 0.75) and of major adverse cardiovascular events (4.0 vs. 6.1, p = 0.26) were reported between COVID-19 and pre-COVID-19 periods. The use of optimized single-hospitalization logistics for TAVI workup and procedure developed during the COVID-19 pandemic, showed to be as safe and effective as the two-stage TAVI pathway previously adopted, allowing the minimization of potential exposure to COVID-19 infection and shortening times to treatment for severely symptomatic patients.
Sections du résumé
BACKGROUND
The coronavirus 2019 (COVID-19) pandemic upset healthcare systems and their logistics worldwide. We sought to assess safety and effectiveness of an optimized logistics for transcatheter aortic valve implantation (TAVI) pathway developed during the COVID-19 pandemic.
METHODS
This is a retrospective analysis. An optimized TAVI logistics based on performing TAVI work-up and procedure during the same hospitalization was used during the COVID-19 pandemic. In-hospital and 30-day outcomes of patients treated during the pandemic were compared with an historical cohort of patients undergoing TAVI with staged work-up before the pandemic within an homogeneous timeframe.
RESULTS
Of 536 patients, 227 (42.4%) underwent TAVI during the COVID-19 pandemic with a reduction of 26.5% compared to the pre-pandemic period (n = 309). The median age was 81 (77-85) years and STS score was 3.4 (2.2-5.6)%. Lower rates of in-hospital major vascular complications (2.2% vs. 8.7%; p < 0.01) and life-threatening bleeding (0.4% vs. 4.2%; p = 0.01) were reported in the COVID-19 period, whereas no difference in acute kidney injury (7.0% vs. 7.4%, p = 0.85) rate was reported between COVID-19 and pre-COVID-19 periods. No difference in 30-day rates of all-cause death (4.0 vs. 4.5, p = 0.75) and of major adverse cardiovascular events (4.0 vs. 6.1, p = 0.26) were reported between COVID-19 and pre-COVID-19 periods.
CONCLUSIONS
The use of optimized single-hospitalization logistics for TAVI workup and procedure developed during the COVID-19 pandemic, showed to be as safe and effective as the two-stage TAVI pathway previously adopted, allowing the minimization of potential exposure to COVID-19 infection and shortening times to treatment for severely symptomatic patients.
Identifiants
pubmed: 35077726
pii: S0167-5273(22)00128-0
doi: 10.1016/j.ijcard.2022.01.038
pmc: PMC8783646
pii:
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
190-194Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2022. Published by Elsevier B.V.
Références
N Engl J Med. 2020 Feb 20;382(8):727-733
pubmed: 31978945
Int J Cardiol. 2022 Jan 15;347:89-96
pubmed: 34740717
J Card Surg. 2021 Jan;36(1):48-55
pubmed: 33084121
N Engl J Med. 2014 Aug 21;371(8):744-56
pubmed: 25140960
Eur J Prev Cardiol. 2022 Mar 30;29(4):e149-e152
pubmed: 34151366
Am J Emerg Med. 2021 Apr;42:203-210
pubmed: 33279331
Am J Cardiol. 2021 Apr 15;145:97-101
pubmed: 33454341
EuroIntervention. 2019 Jun 20;15(2):147-154
pubmed: 30777842
JACC Cardiovasc Interv. 2015 Oct;8(12):1595-604
pubmed: 26386766
J Am Coll Cardiol. 2012 Oct 9;60(15):1438-54
pubmed: 23036636
Circ Cardiovasc Interv. 2017 Aug;10(8):
pubmed: 28768757
Catheter Cardiovasc Interv. 2021 Sep;98(3):E478-E482
pubmed: 33565703
J Thorac Dis. 2021 Feb;13(2):906-917
pubmed: 33717563
EuroIntervention. 2020 Aug 07;16(6):e494-e501
pubmed: 32091404
G Ital Cardiol (Rome). 2020 Jul;21(7):502-508
pubmed: 32555565