Why the study?
The COVID-19 pandemic limited the availability of medical procedures, and its impact on the treatment strategy for severe aortic stenosis was unclear.
Does the COVID-19 pandemic change the treatment strategy and clinical outcomes in patients with severe aortic stenosis?
Does the COVID-19 pandemic change the treatment strategy and clinical outcomes in patients with severe aortic stenosis?
The COVID-19 pandemic shifted the management of severe aortic stenosis toward less invasive TAVI procedures, resulting in shorter hospital stays without compromising short-term mortality.
Answers are grounded in this paper and cite their sources.
Pandemic-era preference for TAVI in severe AS shortened stays without worsening short-term outcomes; leaves open whether this shift should persist beyond resource constraints.
Background: Currently, two effective therapeutic options for severe aortic stenosis (AS) are available, one catheter-based [transcatheter aortic valve implantation (TAVI)], the other open surgical approach [surgical aortic valve replacement (SAVR)]. The COVID-19 pandemic has limited the availability of medical procedures. The purpose of this cross-sectional study was to assess if this pandemic had any impact on the treatment strategy of severe AS in a single cardiac center. Methods: This study involved AS patients treated in 3-month periods (February through April) over 3 consecutive years 2018, 2019 [defined as COV(–) group] and 2020 [COV(+)]. We assessed if there were any differences regarding patients’ clinical profile, applied therapeutic method, procedure complexity and early clinical outcomes. Results: In the years 2018 through 2019, approximately 50% of AS patients were treated classically (SAVR) while in 2020 this rate dropped to 34%. The preoperative clinical characteristic of TAVI subjects was comparable irrespective of the year. Regarding SAVR, more patients in COV(+) underwent urgent and more complex procedures. More of them were found in NYHA class III or IV, and had lower left ventricular ejection fraction (LVEF) (51.9%±14.4% vs. 58.3%±8.1%; P=0.021) than in COV(–) individuals. During the pandemic, a change in applied therapeutic methods and differences in patients’ clinical profile did not have an unfavorable impact on in-hospital mortality (2.0% before vs. 3.6% during pandemic) and morbidity. Of note, intubation time and in-hospital stay were significantly shorter (P<0.05) in 2020 (4.2 hours and 7.5 days) than in the previous years (7.5 hours and 9.0 days, respectively). Conclusions: The coronavirus pandemic has changed substantially the management of severe AS. The shift into less invasive treatment method of AS patients resulted in shortening of in-hospital stay without compromise of short-term outcomes.
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Perek et al. (2021) studied this question.
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