Tuttle Mark K, Poulin Marie-France, Sharma Ravi K, Ho Kalon K L, Casso-Dominguez Abel, Guibone Kimberly, Pinto Duane S, Laham Roger J
Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.
Struct Heart. 2021 Jun;5(6):591-595. doi: 10.1080/24748706.2021.1981561. Epub 2022 Mar 21.
We sought to compare characteristics and outcomes of structural heart disease (SHD) patients treated during the regional peak of the Coronavirus Disease 2019 (COVID-19) pandemic ("COVID era") compared with historical controls. During the COVID era, elective SHD procedures at Beth Israel Deaconess Medical Center were canceled but urgent cases were still performed. We enacted several practice changes in an effort to minimize complications, prevent COVID transmission, and decrease hospital stay during the pandemic.
Baseline characteristics and outcomes were collected on all patients who underwent SHD procedures during the COVID era and compared with patients treated during the same time period in 2019.
Compared with SHD patients treated during 2019 (N = 259), those treated during the COVID era (N = 26) had higher left ventricular end diastolic pressure (LVEDP; 28 vs. 21 mmHg, = 0.001), and were more likely New York Heart Association class IV (26.9% vs. 10.0%, = 0.019), but had a lower rate of bleeding/vascular complications (0% vs. 16.2%, = 0.013), a lower rate of permanent pacemaker implantation (0% vs. 17.4%, = 0.019), and a greater proportion of patients were discharged on post-operative day 1 (POD#1; 68.2% vs. 22.2%, < 0.001).
Practice changes employed for patients treated during the COVID era were associated with fewer vascular complications, a greater proportion of patients discharged on POD#1, and a lower rate of pacemaker implantation despite more severe illness. As a result, we plan to continue these practices in the post-COVID era.
我们试图比较2019年冠状病毒病（COVID-19）大流行区域高峰期（“COVID时代”）接受治疗的结构性心脏病（SHD）患者与历史对照患者的特征和结局。在COVID时代，贝斯以色列女执事医疗中心的择期SHD手术被取消，但紧急病例仍在进行。我们实施了多项实践变革，以尽量减少并发症、防止COVID传播并缩短大流行期间的住院时间。
收集了COVID时代所有接受SHD手术患者的基线特征和结局，并与2019年同期接受治疗的患者进行比较。
与2019年接受治疗的SHD患者（N = 259）相比，COVID时代接受治疗的患者（N = 26）左心室舒张末期压力（LVEDP）更高（28 vs. 21 mmHg，P = 0.001），纽约心脏协会IV级的可能性更大（26.9% vs. 10.0%，P = 0.019），但出血/血管并发症发生率更低（0% vs. 16.2%，P = 0.013），永久起搏器植入率更低（0% vs. 17.4%，P = 0.019），术后第1天出院的患者比例更高（68.2% vs. 22.2%，P < 0.001）。
COVID时代为患者采用的实践变革与血管并发症减少、术后第1天出院的患者比例更高以及起搏器植入率更低相关，尽管病情更严重。因此，我们计划在COVID后时代继续这些做法。
