Rooijakkers M J P, Li W W L, Stens N A, Vis M M, Tonino P A L, Timmers L, Van Mieghem N M, den Heijer P, Kats S, Stella P R, Roolvink V, van der Werf H W, Stoel M G, Schotborgh C E, Amoroso G, Porta F, van der Kley F, van Wely M H, Gehlmann H, van Garsse L A F M, Geuzebroek G S C, Verkroost M W A, Mourisse J M, Medendorp N M, van Royen N
Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands.
Department of Cardiothoracic Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands.
Neth Heart J. 2022 Nov;30(11):503-509. doi: 10.1007/s12471-022-01704-9. Epub 2022 Jun 1.
The coronavirus disease 2019 (COVID-19) pandemic has put tremendous pressure on healthcare systems. Most transcatheter aortic valve implantation (TAVI) centres have adopted different triage systems and procedural strategies to serve highest-risk patients first and to minimise the burden on hospital logistics and personnel. We therefore assessed the impact of the COVID-19 pandemic on patient selection, type of anaesthesia and outcomes after TAVI.
We used data from the Netherlands Heart Registration to examine all patients who underwent TAVI between March 2020 and July 2020 (COVID cohort), and between March 2019 and July 2019 (pre-COVID cohort). We compared patient characteristics, procedural characteristics and clinical outcomes.
We examined 2131 patients who underwent TAVI (1020 patients in COVID cohort, 1111 patients in pre-COVID cohort). EuroSCORE II was comparable between cohorts (COVID 4.5 ± 4.0 vs pre-COVID 4.6 ± 4.2, p = 0.356). The number of TAVI procedures under general anaesthesia was lower in the COVID cohort (35.2% vs 46.5%, p < 0.001). Incidences of stroke (COVID 2.7% vs pre-COVID 1.7%, p = 0.134), major vascular complications (2.3% vs 3.4%, p = 0.170) and permanent pacemaker implantation (10.0% vs 9.4%, p = 0.634) did not differ between cohorts. Thirty-day and 150-day mortality were comparable (2.8% vs 2.2%, p = 0.359 and 5.2% vs 5.2%, p = 0.993, respectively).
During the COVID-19 pandemic, patient characteristics and outcomes after TAVI were not different than before the pandemic. This highlights the fact that TAVI procedures can be safely performed during the COVID-19 pandemic, without an increased risk of complications or mortality.
2019年冠状病毒病（COVID-19）大流行给医疗系统带来了巨大压力。大多数经导管主动脉瓣植入术（TAVI）中心都采用了不同的分诊系统和手术策略，以便首先为最高风险患者提供服务，并尽量减轻医院后勤和人员的负担。因此，我们评估了COVID-19大流行对TAVI术后患者选择、麻醉类型和结局的影响。
我们使用荷兰心脏注册数据，对2020年3月至2020年7月期间接受TAVI的所有患者（COVID队列）以及2019年3月至2019年7月期间接受TAVI的所有患者（COVID前队列）进行了研究。我们比较了患者特征、手术特征和临床结局。
我们研究了2131例接受TAVI的患者（COVID队列中有1020例患者，COVID前队列中有1111例患者）。两队列之间的欧洲心脏手术风险评估系统（EuroSCORE）II相当（COVID组为4.5±4.0，COVID前组为4.6±4.2，p = 0.356）。COVID队列中全身麻醉下进行TAVI手术的数量较少（35.2%对46.5%，p < 0.001）。两队列之间中风发生率（COVID组为2.7%，COVID前组为1.7%，p = 0.134）、主要血管并发症发生率（2.3%对3.4%，p = 0.170）和永久性起搏器植入率（10.0%对9.4%，p = 0.634）无差异。30天和150天死亡率相当（分别为2.8%对2.2%，p = 0.359；5.2%对5.2%，p = 0.993）。
在COVID-19大流行期间，TAVI术后的患者特征和结局与大流行之前没有差异。这突出了一个事实，即在COVID-19大流行期间可以安全地进行TAVI手术，而不会增加并发症或死亡率的风险。
