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Case Reports
. 2020 Nov;2(6):729-731.
doi: 10.1016/j.cjco.2020.08.005. Epub 2020 Aug 21.

Ambulatory TAVR: Early Feasibility Experience During the COVID-19 Pandemic

Oualid Zouaghi  1 , Jérôme Wintzer-Wehekind  1   2 , Yves Lienhart  1 , Mohamed Abdellaoui  1   2 , Benjamin Faurie  1   2
Affiliations
Case Reports

Ambulatory TAVR: Early Feasibility Experience During the COVID-19 Pandemic

Oualid Zouaghi et al. CJC Open. 2020 Nov.

Abstract
in English, French

The COVID-19 pandemic has modified practice for patients with symptomatic aortic stenosis and could result in higher mortality rates due to treatment delays. In this clinical case series, 3 patients underwent ambulatory transcatheter aortic valve replacement (TAVR) thanks to patient and entourage willingness, careful patient selection (including a history of permanent pacemaker placement), and a minimalist procedural approach. No complications occurred during the 30-day follow-up. Performing ambulatory TAVR could reduce the clinical consequences of wait times, minimize exposure to coronavirus contamination, and reduce the use of hospital resources that might be needed for COVID-19 patients. Thanks to a scrupulous minimalist TAVR protocol, ambulatory outpatient management of aortic stenosis was possible in the context of the COVID-19 pandemic.

La pandémie de COVID-19 a modifié la prise en charge des patients présentant une sténose aortique symptomatique, et les retards dans les traitements pourraient entraîner une hausse des taux de mortalité. Dans le cadre de cette série de cas cliniques, trois patients ont subi un remplacement valvulaire aortique par cathéter (RVAC) ambulatoire, rendu possible grâce à la volonté des patients et de leur entourage, aux choix consciencieux des candidats (par exemple, les receveurs d’un stimulateur cardiaque implantable) et à une approche comportant des interventions minimales. On n’a observé aucune complication durant les 30 jours du suivi. Le RVAC ambulatoire pourrait atténuer les répercussions cliniques associées au temps d’attente, réduire le risque d’exposition au coronavirus et diminuer l’utilisation des ressources hospitalières, qui pourraient être consacrées aux patients atteints de la COVID-19. Un protocole méticuleux et minimaliste de RVAC a permis la prise en charge ambulatoire de la sténose aortique durant la pandémie de COVID-19.

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Figures

Figure 1
Figure 1
Example of an ambulatory transcatheter aortic valve replacement using a virtual reality google system. (A): Ambulatory transcatheter aortic valve replacement procedural set-up with virtual reality Google system to optimize conscious sedation and the left distal radial approach as secondary access. (B) Direct deployment of an Edwards Sapien 26-mm balloon-expandable valve (Edwards Lifesciences Corp, Irvine, CA) under direct left ventricular rapid pacing at 160 per minute in a patient with a previously placed permanent pacemaker.
See this image and copyright information in PMC

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