Oxford Heart Center, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
Oxford Heart Center, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; Department of Cardiovascular Medicine, University of Oxford, Oxford, UK.
Cardiovasc Revasc Med. 2021 Oct;31:26-31. doi: 10.1016/j.carrev.2020.12.002. Epub 2020 Dec 3.
The risk of nosocomial COVID-19 infection for vulnerable aortic stenosis patients and intensive care resource utilization has led to cardiac surgery deferral. Untreated severe symptomatic aortic stenosis has a dismal prognosis. TAVR offers an attractive alternative to surgery as it is not reliant on intensive care resources. We set out to explore the safety and operational efficiency of restructuring a TAVR service and redeploying it to a new non-surgical site during the COVID-19 pandemic.
The institutional prospective service database was retrospectively interrogated for the first 50 consecutive elective TAVR cases prior to and after our institution's operational adaptations for the COVID-19 pandemic. Our endpoints were VARC-2 defined procedural complications, 30-day mortality or re-admission and service efficiency metrics.
The profile of patients undergoing TAVR during the pandemic was similar to patients undergoing TAVR prior to the pandemic with the exception of a lower mean age (79 vs 82 years, p < 0.01) and median EuroScore II (3.1% vs 4.6%, p = 0.01). The service restructuring and redeployment contributed to the pandemic-mandated operational efficiency with a reduction in the distribution of pre-admission hospital visits (3 vs 3 visits, p < 0.001) and the time taken from TAVR clinic to procedure (26 vs 77 days, p < 0.0001) when compared to the pre-COVID-19 service. No statistically significant difference was noted in peri-procedural complications and 30-day outcomes, while post-operative length of stay was significantly reduced (2 vs 3 days, p < 0.0001) when compared to pre-COVID-19 practice.
TAVR service restructuring and redeployment to align with pandemic-mandated healthcare resource rationalization is safe and feasible.
COVID-19 医院感染风险和重症监护资源的利用导致心脏手术推迟。未经治疗的严重症状性主动脉瓣狭窄预后不佳。TAVR 为手术提供了一种有吸引力的替代方法，因为它不依赖于重症监护资源。我们着手探索在 COVID-19 大流行期间，重组 TAVR 服务并将其重新部署到新的非手术地点的安全性和运营效率。
回顾性分析机构前瞻性服务数据库中 COVID-19 大流行期间机构运营调整前后的前 50 例连续择期 TAVR 病例。我们的终点是 VARC-2 定义的程序并发症、30 天死亡率或再入院率和服务效率指标。
大流行期间接受 TAVR 的患者的特征与大流行前接受 TAVR 的患者相似，除了平均年龄较低（79 岁 vs 82 岁，p < 0.01）和中位数 EuroScore II 较低（3.1% vs 4.6%，p = 0.01）。服务重组和重新部署有助于满足大流行期间的运营效率要求，减少了术前医院就诊次数（3 次就诊 vs 3 次就诊，p < 0.001）和从 TAVR 诊所到手术的时间（26 天 vs 77 天，p < 0.0001）与 COVID-19 前服务相比。围手术期并发症和 30 天结局无统计学差异，而与 COVID-19 前实践相比，术后住院时间明显缩短（2 天 vs 3 天，p < 0.0001）。
TAVR 服务重组和重新部署以适应大流行期间医疗资源合理化是安全可行的。
