Debra L. Beck and Eugene Braunwald, MD
Published: April 13, 2020
The COVID-19 pandemic has strained healthcare resources in many locales. Hospitals have stopped or limited elective procedures and are re-organizing the way in which they provide urgent, non-COVID-19 care. Individuals in need of structural heart disease (SHD) intervention constitute a challenging group because their conditions may be life-threatening if intervention is inappropriately delayed.
Shah and colleagues from the American College of Cardiology (ACC) and the Society for Angiography and Intervention (SCAI) wrote a consensus statement focused on how to best triage patients with valvular and structural heart disease (SHD) who have been referred for intervention, in particular transcatheter aortic valve replacement (TAVR) and percutaneous mitral valve repair. They also address procedural issues and considerations for the function of SHD teams during the COVID-19 pandemic.
Four principles are given to guide all decision making: a) prevent transmission of coronavirus to patients and providers; b) maintain high quality and durable SHD care for those who must have a procedure during the pandemic; c) reduce the risk of these patients using resources that are needed to treat COVID-19; and d) prevent treatment delay that could lead to clinical deterioration, heart failure, or death.
The writing group proposed timing of TAVR for patients with different severities of aortic stenosis, when treatment is urgent and when it can be postponed. They make similar recommendations for candidates for transcatheter mitral valve procedures, valve-in-valve replacements, and other SHD interventions. Telemedicine should be used to monitor patients whose procedures are deferred such that changes in symptoms and functioning are noted and acted upon, when appropriate.
All clinic visits should be shifted to virtual visits, to the extent possible. If a procedure is needed, pre-procedure visits and imaging should be consolidated to a single encounter.
During a procedure, pre-procedural transesophageal echocardiography (TEE) should be limited to avoid risk of particular aerosolization. PPE guidelines should be carefully adhered to.
And finally, the authors suggest that clinical trial enrollment should be deferred until after “adequate resolution” of the pandemic. Individuals already enrolled and treated should be maintained.
References
Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine features a unique update program by Dr. Braunwald, creating a “living textbook” by featuring twice monthly updates including “Hot off the Press” and Late-Breaking Clinical Trials (links to authors’ presentation slides are also included).
Learn more about Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine, 11th Edition. Download a free chapter here.
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