Billy Matthew J, Brennan Zachary, Ahmad Tariq, Conte John V, Wallen Tyler J
General Surgery, Geisinger Commonwealth School of Medicine, Scranton, USA.
Surgery, Michigan State University College of Osteopathic Medicine, East Lansing, USA.
Cureus. 2023 Jul 13;15(7):e41837. doi: 10.7759/cureus.41837. eCollection 2023 Jul.
Transcatheter aortic valve replacement (TAVR) has become the dominant form of aortic valve replacement in the United States. During the Coronavirus disease 2019 (COVID-19) pandemic, access to elective surgical care was decreased, particularly for TAVR patients. In this study, we examine the impact of each COVID-19 "wave," on our patient's access to TAVR procedures and their associated outcomes. Methods: After institutional review board approval, we conducted a retrospective review of a prospectively maintained database and a review of our own center's database to assess time to TAVR pre-COVID-19 and during internally defined COVID-19 "waves." Statistical analysis was conducted via a t-test.
We measured the time from first contact to TAVR and compared each COVID-19 wave to our institution's pre-COVID-19 data. During Wave 1 and 2 of COVID-19, our mean time to TAVR increased significantly to 68.44 ± 48.66 days (p = 0.05) and 68.94 ± 53.16 days (p = 0.02), respectively. All three COVID-19 waves demonstrated a statistically significant increase in all-cause mortality post-operatively (PO) with mean PO mortality of 2.5 (p = 0.0035), 1.33 (p = 0.0009), and 0.67 (p = 0.006), respectively, compared to pre-COVID-19 data. Conclusions: Multiple studies have shown that increased time from first contact to TAVR results in increased morbidity and mortality. COVID-19 increased our institution's time to TAVR significantly across two waves with an increase in all-cause mortality in each wave. This study highlights the importance that institutions should develop mechanisms to ensure access to care during crises so that patients do not face potentially avoidable harm.
经导管主动脉瓣置换术（TAVR）已成为美国主动脉瓣置换的主要方式。在2019年冠状病毒病（COVID-19）大流行期间，择期手术治疗的可及性下降，尤其是对于TAVR患者。在本研究中，我们探讨了每一波COVID-19对我们患者接受TAVR手术的可及性及其相关结局的影响。方法：经机构审查委员会批准后，我们对一个前瞻性维护的数据库进行了回顾性审查，并对我们自己中心的数据库进行了审查，以评估COVID-19之前及内部定义的COVID-19“波次”期间至TAVR的时间。通过t检验进行统计分析。
我们测量了从首次接触到TAVR的时间，并将每一波COVID-19与我们机构COVID-19之前的数据进行比较。在COVID-19的第1波和第2波期间，我们至TAVR的平均时间分别显著增加至68.44±48.66天（p = 0.05）和68.94±53.16天（p = 0.02）。与COVID-19之前的数据相比，所有三波COVID-19均显示术后全因死亡率有统计学显著增加，平均术后死亡率分别为2.5（p = 0.0035）、1.33（p = 0.0009）和0.67（p = 0.006）。结论：多项研究表明，从首次接触到TAVR的时间增加会导致发病率和死亡率上升。COVID-19在两波期间显著增加了我们机构至TAVR的时间，且每一波的全因死亡率均有所增加。本研究强调了机构应制定机制以确保在危机期间获得医疗服务的重要性，这样患者就不会面临潜在的可避免伤害。
