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Review
. 2020 Aug 24;13(16):1937-1944.
doi: 10.1016/j.jcin.2020.05.045. Epub 2020 Jun 1.

Managing Severe Aortic Stenosis in the COVID-19 Era

Varsha K Tanguturi  1 , Brian R Lindman  2 , Philippe Pibarot  3 , Jonathan J Passeri  4 , Samir Kapadia  5 , Michael J Mack  6 , Ignacio Inglessis  4 , Nathan B Langer  7 , Thoralf M Sundt  7 , Judy Hung  4 , Sammy Elmariah  8
Affiliations
Review

Managing Severe Aortic Stenosis in the COVID-19 Era

Varsha K Tanguturi et al. JACC Cardiovasc Interv. .

Abstract

The novel coronavirus disease-2019 (COVID-19) pandemic has created uncertainty in the management of patients with severe aortic stenosis. This population experiences high mortality from delays in treatment of valve disease but is largely overlapping with the population of highest mortality from COVID-19. The authors present strategies for managing patients with severe aortic stenosis in the COVID-19 era. The authors suggest transitions to virtual assessments and consultation, careful pruning and planning of necessary testing, and fewer and shorter hospital admissions. These strategies center on minimizing patient exposure to COVID-19 and expenditure of human and health care resources without significant sacrifice to patient outcomes during this public health emergency. Areas of innovation to improve care during this time include increased use of wearable and remote devices to assess patient performance and vital signs, devices for facile cardiac assessment, and widespread use of clinical protocols for expedient discharge with virtual physical therapy and cardiac rehabilitation options.

Keywords: COVID-19; SAVR; TAVR; aortic stenosis.

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Figures

Figure 1
Figure 1
Risks of Treating Severe AS Balanced With Risks of Delayed Treatment AS = aortic stenosis; COVID-19 = coronavirus disease-2019; ICU = intensive care unit; PPE = personal protective equipment.
Figure 2
Figure 2
Suggested Treatment Strategies for Patients With Severe Symptomatic AS CTA = computed tomographic angiography; PCI = percutaneous coronary intervention; PFT = pulmonary function test; SAVR = surgical aortic valve replacement; TAVR = transcatheter aortic valve replacement; other abbreviations as in Figure 1.
Figure 3
Figure 3
Areas of Innovation to Facilitate Care of Patients With Severe Aortic Stenosis BP = blood pressure; ECG = electrocardiographic.
See this image and copyright information in PMC

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