Ooms Joris F, Hokken Thijmen W, Adrichem Rik, Gunes Dilay, de Ronde-Tillmans Marjo, Kardys Isabella, Goudzwaard Jeannette, Mattace-Raso Francesco, Nuis Rutger-Jan, Daemen Joost, Van Mieghem Nicolas M
Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands.
Department of Internal Medicine, Section of Geriatrics, Erasmus University Medical Centre, Rotterdam, The Netherlands.
Neth Heart J. 2023 Oct;31(10):399-405. doi: 10.1007/s12471-023-01795-y. Epub 2023 Jul 27.
INTRODUCTION: Delays in the diagnosis and referral of aortic stenosis (AS) during the coronavirus disease 2019 (COVID-19) pandemic may have affected the haemodynamic status of AS patients. We aimed to compare clinical and haemodynamic characteristics of severe AS patients referred for transcatheter aortic valve implantation (TAVI) or balloon aortic valvuloplasty (BAV) before the pandemic versus two subsequent periods. METHODS: This study compared three 1‑year historical cohorts: a pre-COVID-19 group (PCOV), a 1st-year COVID-19 group (COV-Y1) and a 2nd-year COVID-19 group (COV-Y2). The main parameters were baseline New York Heart Association (NYHA) functional class, left ventricular ejection fraction (LVEF) and left ventricular end-diastolic pressure (LVEDP). Demographics, procedural characteristics and 30-day clinical outcomes were assessed. The transition time between heart team decision and TAVI was examined. Pairwise group comparisons were performed (PCOV vs COV-1Y and COV-1Y vs COV-2Y). RESULTS: A total of 720 patients were included with 266, 249 and 205 patients in the PCOV, COV-Y1 and COV-Y2 groups, respectively. BAV was performed in 28 patients (4%). NYHA class did not differ across the cohorts. Compared to PCOV, LVEF was slightly lower in COV-Y1 (58% (49-60%) vs 57% (45-60%), p = 0.03); no difference was observed when comparing COV-Y1 and COV-Y2. LVEDP was higher in COV-Y1 than in PCOV (20 mm Hg (16-26 mm Hg) vs 17 mm Hg (13-24 mm Hg), p = 0.01). No difference was found when comparing LVEDP between COV-Y1 and COV-Y2. Thirty-day mortality did not differ between groups. Transition time was reduced in the COVID era. Duration of hospital stay declined over the study period. CONCLUSIONS: Patients undergoing TAVI during the COVID-19 pandemic had more advanced AS illustrated by lower LVEF and higher LVEDP, but there were no differences in clinical outcome. The TAVI pathway became more efficient.
引言:2019年冠状病毒病(COVID-19)大流行期间,主动脉瓣狭窄(AS)诊断和转诊的延迟可能影响了AS患者的血流动力学状态。我们旨在比较在大流行之前与随后两个时期接受经导管主动脉瓣植入术(TAVI)或球囊主动脉瓣成形术(BAV)的重度AS患者的临床和血流动力学特征。 方法:本研究比较了三个1年的历史队列:COVID-19前组(PCOV)、COVID-19第1年组(COV-Y1)和COVID-19第2年组(COV-Y2)。主要参数为基线纽约心脏协会(NYHA)功能分级、左心室射血分数(LVEF)和左心室舒张末期压力(LVEDP)。评估了人口统计学、手术特征和30天临床结局。检查了心脏团队决策与TAVI之间的过渡时间。进行了组间两两比较(PCOV与COV-1Y以及COV-1Y与COV-2Y)。 结果:共纳入720例患者,PCOV组、COV-Y1组和COV-Y2组分别有266例、249例和205例患者。28例患者(4%)接受了BAV。各队列的NYHA分级无差异。与PCOV相比,COV-Y1的LVEF略低(58%(49-60%)对57%(45-60%),p = 0.03);比较COV-Y1和COV-Y2时未观察到差异。COV-Y1的LVEDP高于PCOV(20 mmHg(16-26 mmHg)对17 mmHg(13-24 mmHg),p = 0.01)。比较COV-Y1和COV-Y2之间的LVEDP时未发现差异。各组间30天死亡率无差异。COVID时代过渡时间缩短。住院时间在研究期间有所下降。 结论:在COVID-19大流行期间接受TAVI的患者AS程度更严重,表现为LVEF较低和LVEDP较高,但临床结局无差异。TAVI流程变得更高效。
Front Cardiovasc Med. 2022-7-28
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