Key result
TAVI referral during the first year of COVID-19 was associated with lower LVEF and higher LVEDP vs pre-COVID-19, with no difference in 30-day mortality.
Why the study?
Delays in the diagnosis and referral of aortic stenosis during the COVID-19 pandemic may have affected the haemodynamic status of patients referred for TAVI or BAV.
Cohort (n=720)
No
Answers are grounded in this paper and cite their sources.
Observational cohort study shows worse haemodynamics during COVID-19 in severe aortic stenosis, indicating preserved short-term outcomes despite disease progression.
INTRODUCTION: Delays in the diagnosis and referral of aortic stenosis (AS) during the coronavirus disease 2019 (COVID-19) pandemic may have affected the haemodynamic status of AS patients. We aimed to compare clinical and haemodynamic characteristics of severe AS patients referred for transcatheter aortic valve implantation (TAVI) or balloon aortic valvuloplasty (BAV) before the pandemic versus two subsequent periods. METHODS: This study compared three 1‑year historical cohorts: a pre-COVID-19 group (PCOV), a 1st-year COVID-19 group (COV-Y1) and a 2nd-year COVID-19 group (COV-Y2). The main parameters were baseline New York Heart Association (NYHA) functional class, left ventricular ejection fraction (LVEF) and left ventricular end-diastolic pressure (LVEDP). Demographics, procedural characteristics and 30-day clinical outcomes were assessed. The transition time between heart team decision and TAVI was examined. Pairwise group comparisons were performed (PCOV vs COV-1Y and COV-1Y vs COV-2Y). RESULTS: A total of 720 patients were included with 266, 249 and 205 patients in the PCOV, COV-Y1 and COV-Y2 groups, respectively. BAV was performed in 28 patients (4%). NYHA class did not differ across the cohorts. Compared to PCOV, LVEF was slightly lower in COV-Y1 (58% (49-60%) vs 57% (45-60%), p = 0.03); no difference was observed when comparing COV-Y1 and COV-Y2. LVEDP was higher in COV-Y1 than in PCOV (20 mm Hg (16-26 mm Hg) vs 17 mm Hg (13-24 mm Hg), p = 0.01). No difference was found when comparing LVEDP between COV-Y1 and COV-Y2. Thirty-day mortality did not differ between groups. Transition time was reduced in the COVID era. Duration of hospital stay declined over the study period. CONCLUSIONS: Patients undergoing TAVI during the COVID-19 pandemic had more advanced AS illustrated by lower LVEF and higher LVEDP, but there were no differences in clinical outcome. The TAVI pathway became more efficient.
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Ooms et al. (2023) conducted a cohort in Severe aortic stenosis or degenerated aortic bioprosthesis (n=720). COVID-19 pandemic period (Year 1 and Year 2) vs. Pre-COVID-19 period was evaluated on Left ventricular end-diastolic pressure (LVEDP, mm Hg) (p=0.01). TAVI referral during the first year of COVID-19 was associated with lower LVEF and higher LVEDP vs pre-COVID-19, with no difference in 30-day mortality.
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