Angellotti Domenico, Manzo Rachele, Castiello Domenico Simone, Piccolo Raffaele, Avvedimento Marisa, Leone Attilio, Ilardi Federica, Mariani Andrea, Iapicca Cristina, Di Serafino Luigi, Cirillo Plinio, Franzone Anna, Esposito Giovanni
Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.
Acta Cardiol. 2022 Dec;77(10):937-942. doi: 10.1080/00015385.2022.2119660. Epub 2022 Oct 5.
We sought to investigate the applicability and outcomes of a novel system to manage patients requiring transcatheter aortic valve implantation (TAVI) at a tertiary level hospital during the coronavirus disease-2019 (COVID-19) pandemic.
To analyse the impact of hospitalisation pathways during the pandemic on clinical outcomes of TAVI patients, the study population was divided into two groups (pre-pandemic and pandemic groups) and all perioperative/follow-up data were compared. The primary endpoint was all-cause mortality at 30 days; secondary endpoints included procedural success and short-term complications.
A total of 315 patients received TAVI during the study period. Pandemic group ( = 77) showed a more complex baseline clinical profile (NYHA class III-IV, 70.1% vs. 56.3%; = 0.03). The overall time to procedure was significantly longer during pandemic (56.9 ± 68.3 vs.37.7 ± 25.4; = 0.004) while intensive care unit stay was shorter (2.2 ± 1.4 vs. 3.7 ± 3.9, < 0.05). Hospitalisation length was similar in both groups as well as all-cause mortality rate and the incidence of major periprocedural complications. No case of infection by COVID-19 was reported among patients during the hospital stay.
Comparative analysis of early clinical outcomes showed that COVID-19 pandemic did not affect the safety and effectiveness of TAVI as similar rates of procedural complications and all-cause mortality were reported than before February 2020. Despite the increased time lag between diagnosis and procedure and a more complex clinical profile of patients at baseline, the revised pathway of hospitalisation allowed to resume inpatient procedures while not affecting patients' and healthcare workers' safety.
我们试图研究一种新型系统在2019年冠状病毒病（COVID-19）大流行期间，于一家三级医院管理需要经导管主动脉瓣植入术（TAVI）患者的适用性和结果。
为分析大流行期间住院途径对TAVI患者临床结果的影响，研究人群分为两组（大流行前组和大流行组），并比较所有围手术期/随访数据。主要终点是30天时的全因死亡率；次要终点包括手术成功率和短期并发症。
在研究期间共有315例患者接受了TAVI。大流行组（n = 77）显示出更复杂的基线临床特征（纽约心脏协会III-IV级，70.1%对56.3%；P = 0.03）。大流行期间手术的总时间明显更长（56.9±68.3对37.7±25.4；P = 0.004），而重症监护病房停留时间更短（2.2±1.4对3.7±3.9，P<0.05）。两组的住院时间、全因死亡率和主要围手术期并发症的发生率相似。住院期间患者中未报告COVID-19感染病例。
早期临床结果的比较分析表明，COVID-19大流行并未影响TAVI的安全性和有效性，因为报告的手术并发症和全因死亡率与2020年2月之前相似。尽管诊断和手术之间的时间间隔增加，且患者基线临床特征更复杂，但修订后的住院途径允许恢复住院手术，同时不影响患者和医护人员的安全。
