CIDRAP recently featured JAMA NetworkOpen’s online reports of two timely research letters. The letters outlined the complications that may arise for aortic stenosis patients who have had to delay transaortic valve replacement (TAVR) during the COVID-19 pandemic.
TAVR is classified as a minimally invasive procedure that replaces an aortic valve when it does not function properly. This prevents or reduces the flow of blood from the heart through the main artery and throughout the body. It is called aortic valve stenosis.
Surgery is generally required. If the condition is left untreated, serious heart problems may arise. TAVR is also to be considered in instances where patients may be at medium to high risk for open-heart surgery (aortic valve replacement).
COVID-19 And the First Study
Data from seventy-seven patients was analyzed in the first study at New York’s Mount Sinai Hospital. As of March 22, 2020, TAVI diagnostic tests had been canceled as a result of an executive order halting elective surgeries.
These steps were taken in an effort to reduce the spread of COVID-19 at the hospitals as well as to preserve staff and resources.
There were no deaths attributed to aortic stenosis in the three months prior to the ban on elective surgery. But while waiting for treatment in the following months eight patients had a cardiac event. Six of the eight patients had emergency TAVR, and two died.
As of June 6, 2020, the hospital was allowed to resume its elective procedures. However, researchers discovered that there were twenty-seven cardiac events. Twenty-four of the seventy-seven patients required emergency TAVR. There was a total of three deaths.
The researchers cautioned that patients with aortic stenosis should be considered high risk and be given early access to TAVR if and whenever possible.
About the Second Study
The second study, conducted at Switzerland’s Bern University, reviewed the outcome for TAVR in seventy-one patients with aortic stenosis. The ban on elective surgery went into effect on March 20, 2020 and was lifted on April 26, 2020.
A Critical Comparison
The researchers conducted a follow-up after thirty-one days. They found that patients whose TAVR was delayed had been hospitalized for worsening heart failure and stenosis symptoms.
But the patients whose procedures had been fast-tracked had neither heart failure nor stenosis symptoms.
In addition, forty-four percent of patients in the deferred group had multivalvular disease which results from non-functioning heart valves. In comparison, only eight percent of patients in the expedited group exhibited multivalvular disease.
The Experts’ Opinion
Dr. Thoralf Sundt offered his opinion by noting that symptomatic aortic stenosis should be treated as a life-or-death situation. Doctors should take emergency measures when treating patients in advanced stages of the disease.
The doctor further stated that patients prefer transcatheter aortic valve replacement as opposed to surgery, especially since it gives less exposure to COVID-19 which is associated with hospital stays.
