Department of Cardiology, Pomeranian Medical University, Szczecin, Poland
Clinical Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of the Interior and Administration, Centre of Postgraduate Medical Education, Warsaw, Poland
Kardiol Pol. 2020 May 25;78(5):498-507. doi: 10.33963/KP.15358. Epub 2020 May 15.
The ongoing pandemic of coronavirus disease 2019 (COVID‑19), caused by severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2), represents a major challenge for healthcare. The involvement of cardiovascular system in COVID‑19 has been proven and increased healthcare system resources are redirected towards handling infected patients, which induces major changes in access to services and prioritization in the management of patients with chronic cardiovascular disease unrelated to COVID‑19. In this expert opinion, conceived by the task force involving the Working Groups on Valvular Heart Diseases and Cardiac Surgery as well as the Association of Cardiovascular Intervention of the Polish Cardiac Society, modification of diagnostic pathways, principles of healthcare personnel protection, and treatment guidelines regarding triage and prioritization are suggested. Heart Teams responsible for the treatment of valvular heart disease should continue their work using telemedicine and digital technology. Diagnostic tests must be simplified or deferred to minimize the number of potentially dangerous aerosol‑generating procedures, such as transesophageal echocardiography or exercise imaging. The treatment of aortic stenosis and mitral regurgitation has to be offered particularly due to urgent indications and in patients with advanced disease and poor prognosis. Expert risk stratification is essential for triage and setting the priority lists. In each case, an appropriate level of personal protection must be ensured for the healthcare personnel to prevent spreading infection and preserve specialized manpower, who will supply the continuing need for handling serious chronic cardiovascular disease. Importantly, as soon as the local epidemic situation improves, efforts must be made to restore standard opportunities for elective treatment of valvular heart disease and occluder‑based therapies according to existing guidelines, thus rebuilding the state ‑of ‑the ‑art cardiovascular services.
由严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）引起的 2019 年冠状病毒病（COVID-19）大流行是对医疗保健的重大挑战。已经证明心血管系统参与了 COVID-19，并且增加了医疗保健系统资源，以处理感染患者，这导致了与 COVID-19 无关的慢性心血管疾病患者服务获取和管理优先级的重大变化。在这个专家意见中，由波兰心脏病学会瓣膜心脏病和心脏外科工作组以及心血管介入协会的工作组提出了修改诊断途径、保护医疗保健人员的原则以及分诊和优先级治疗指南的建议。负责治疗瓣膜性心脏病的心脏团队应继续使用远程医疗和数字技术开展工作。必须简化诊断测试或推迟测试，以尽量减少潜在危险的气溶胶产生程序（如经食管超声心动图或运动成像）的数量。由于紧急指征和晚期疾病及预后不良的患者，必须提供主动脉瓣狭窄和二尖瓣反流的治疗。专家风险分层对于分诊和设置优先级列表至关重要。在每种情况下，都必须确保医疗保健人员的适当个人防护水平，以防止感染传播并保护专门的人力，这些人力将满足处理严重慢性心血管疾病的持续需求。重要的是，一旦当地疫情状况改善，就必须努力根据现有指南恢复瓣膜性心脏病和基于封堵器的治疗的标准择期治疗机会，从而重建最新的心血管服务。
