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在新冠疫情时代管理严重主动脉瓣狭窄。

Managing Severe Aortic Stenosis in the COVID-19 Era.

机构信息

Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.

Structural Heart and Valve Center, Vanderbilt University School of Medicine, Nashville, Tennessee.

出版信息

JACC Cardiovasc Interv. 2020 Aug 24;13(16):1937-1944. doi: 10.1016/j.jcin.2020.05.045. Epub 2020 Jun 1.

Abstract

The novel coronavirus disease-2019 (COVID-19) pandemic has created uncertainty in the management of patients with severe aortic stenosis. This population experiences high mortality from delays in treatment of valve disease but is largely overlapping with the population of highest mortality from COVID-19. The authors present strategies for managing patients with severe aortic stenosis in the COVID-19 era. The authors suggest transitions to virtual assessments and consultation, careful pruning and planning of necessary testing, and fewer and shorter hospital admissions. These strategies center on minimizing patient exposure to COVID-19 and expenditure of human and health care resources without significant sacrifice to patient outcomes during this public health emergency. Areas of innovation to improve care during this time include increased use of wearable and remote devices to assess patient performance and vital signs, devices for facile cardiac assessment, and widespread use of clinical protocols for expedient discharge with virtual physical therapy and cardiac rehabilitation options.

摘要

新型冠状病毒病-2019(COVID-19)大流行给严重主动脉瓣狭窄患者的治疗管理带来了不确定性。这部分人群因瓣膜疾病治疗延迟而死亡率很高,但与 COVID-19 死亡率最高的人群大部分重叠。作者提出了在 COVID-19 时代管理严重主动脉瓣狭窄患者的策略。作者建议向虚拟评估和咨询过渡,谨慎地修剪和计划必要的检查,并减少和缩短住院时间。这些策略的核心是尽量减少患者接触 COVID-19 的风险,以及在不显著影响患者预后的情况下,节约人力和医疗资源,这是在此次公共卫生紧急事件期间。为改善在此期间的护理而进行的创新领域包括更多地使用可穿戴和远程设备来评估患者的表现和生命体征、用于方便心脏评估的设备,以及广泛使用临床方案以便在虚拟物理治疗和心脏康复选择下迅速出院。

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