Structured Allocation of Transcatheter Aortic Valve Replacement Patients during Coronavirus Disease 2019 Pandemic: Impact on Patient Selection and Clinical Results.
Nora BerishaKathrin KleinVerena VeulemansOliver MaierKerstin PiaydaStephan BinnebößelShazia AfzalAmin PolzinRalf WestenfeldPatrick HornChristian JungMalte KelmChristine QuastTobias ZeusPublished in: Journal of cardiovascular development and disease (2022)
Due to shortages of medical resources during the Coronavirus Disease 2019 (COVID-19) pandemic, an allocation algorithm for Transcatheter Aortic Valve Replacement (TAVR) was established. We investigated the impact on patient selection and procedural results. In total, 456 TAVR patients before (pre-COVID-19 group) and 456 TAVR patients after (COVID-19 group) the implementation of our allocation algorithm were compared. Concerning patient characteristics, the COVID-19 group revealed a higher rate of cardiac decompensations/cardiogenic shocks (10.5% vs. 1.3%; p < 0.001), severe angina pectoris (Canadian Cardiovascular Society (CCS) II, III and IV: 18.7% vs. 11.8%; p = 0.004), troponin elevation (>14 ng/L: 84.9% vs. 77%; p = 0.003) and reduced left ventricular ejection fraction (LVEF) (<45%: 18.9% vs. 12%; p = 0.006). Referring to procedural characteristics, more predilatations (46.3% vs. 35.1%; p = 0.001) and a longer procedural time (80.2 min (+/-29.4) vs. 66.9 min (+/-17.5); p < 0.001) were observed. The success rate was evenly high; no differences in safety parameters were reported. Examining the utilization of hospital resources, the COVID-19 group showed a shorter in-hospital stay (8.4 days (+/-5.9) vs. 9.5 days (+/-9.33); p = 0.041) and fewer TAVR patients were treated per month (39 (+/-4.55) vs. 46.11 (+/-7.57); p = 0.03). Our allocation algorithm supported prioritization of sicker patients with similar efficient and safe TAVR procedures. In-hospital stay could be shortened.
Keyphrases
- ejection fraction
- aortic stenosis
- coronavirus disease
- transcatheter aortic valve replacement
- end stage renal disease
- aortic valve
- sars cov
- newly diagnosed
- chronic kidney disease
- left ventricular
- healthcare
- prognostic factors
- peritoneal dialysis
- primary care
- emergency department
- heart failure
- case report
- coronary artery disease
- acute myocardial infarction
- mass spectrometry
- early onset
- single cell
- atrial fibrillation