Shafi Ahmed M A, Awad Wael I
Department of Cardiothoracic Surgery, Bart's Heart Centre, St Bartholomew's Hospital, London, UK.
J Card Surg. 2021 Jan;36(1):260-264. doi: 10.1111/jocs.15182. Epub 2020 Nov 1.
COVID-19 has had a dramatic impact on the provision of healthcare. COVID-19 can manifest with cardiac and thrombotic presentations. Additionally, patients with cardiovascular comorbidities are at an increased risk of adverse outcomes related to COVID-19 infection. This in turn has led to a significant reduction in the provision of cardiac surgery with alternative management options utilized to address patients with significant disease. In terms of aortic valve disease, transcatheter aortic valve implantation (TAVI) provides advantages over surgical aortic valve replacement in with a lower burden on healthcare resources. COVID-19 also resulted in changes in management strategies and as such TAVI is now being considered in younger- and low-risk patients. However, long term data with regard to TAVI is still unknown, and the use in patient groups that have been excluded in the large pivotal studies that established TAVI as an alternative to surgery has raised specific concerns in the use of TAVI as the preferred treatment choice. With the long term ramification unknown, it is essential that decisions are made with caution.
新冠疫情对医疗保健服务产生了巨大影响。新冠病毒感染可能表现为心脏和血栓相关症状。此外，患有心血管合并症的患者因感染新冠病毒而出现不良后果的风险增加。这反过来又导致心脏手术的实施显著减少，转而采用替代管理方案来治疗重症患者。就主动脉瓣疾病而言，经导管主动脉瓣植入术（TAVI）相较于外科主动脉瓣置换术具有优势，对医疗资源的负担较小。新冠疫情还导致了管理策略的改变，因此现在正在考虑对年轻和低风险患者采用TAVI。然而，关于TAVI的长期数据仍然未知，并且在将TAVI确立为手术替代方案的大型关键研究中被排除的患者群体中使用TAVI，引发了对将其作为首选治疗选择的具体担忧。由于长期影响未知，谨慎做出决策至关重要。
