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. 2023 Oct;31(10):399-405.
doi: 10.1007/s12471-023-01795-y. Epub 2023 Jul 27.

Changing haemodynamic status of patients referred for transcatheter aortic valve intervention during the COVID-19 pandemic

Joris F Ooms  1 , Thijmen W Hokken  1 , Rik Adrichem  1 , Dilay Gunes  1 , Marjo de Ronde-Tillmans  1 , Isabella Kardys  1 , Jeannette Goudzwaard  2 , Francesco Mattace-Raso  2 , Rutger-Jan Nuis  1 , Joost Daemen  1 , Nicolas M Van Mieghem  3
Affiliations

Changing haemodynamic status of patients referred for transcatheter aortic valve intervention during the COVID-19 pandemic

Joris F Ooms et al. Neth Heart J. 2023 Oct.

Erratum in

Abstract

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.

Keywords: COVID-19; Haemodynamics; Transcatheter aortic valve implantation.

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Conflict of interest statement

J. Daemen received institutional grant/research support from Astra Zeneca, Abbott Vascular, Boston Scientific, ACIST Medical, Medtronic, Pie Medical and ReCor Medical. N.M. Van Mieghem received research grant support from Abbott Vascular, Boston Scientific, Medtronic, Edwards Lifesciences, Daiichi Sankyo and PulseCath BV.J.F. Ooms, T.W. Hokken, R. Adrichem, D. Gunes, M. de Ronde-Tillmans, I. Kardys, J. Goudzwaard, F. Mattace-Raso and R.-J. Nuis declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Infographic. A single center observational study comparing clinical and hemodynamic characteristics of three successive one-year historical cohorts of TAVI patients. LVEDP left ventricular end diastolic pressure, LVEF left ventricular ejection fraction, NYHA New York Heart Association functional classification, TAVI transcatheter aortic valve implantation
Fig. 2
Fig. 2
Transition time and length of hospital stay in pre-COVID versus COVID era groups. Bars represent interquartile range with left and right margins corresponding to the 25th and 75th percentile, respectively. The black line within each bar signifies the group median. Transition time is defined as time between heart team decision and transcatheter aortic valve implantation
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