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Transcatheter management of severe aortic stenosis during the COVID-19 pandemic
  1. Bharat Khialani1,
  2. Philip MacCarthy2
  1. 1 Papworth Hospital NHS Foundation Trust, Cambridge, Cambridgeshire, UK
  2. 2 Department of Cardiology, King's College Hospital NHS Foundation Trust, London, UK
  1. Correspondence to Professor Philip MacCarthy, Cardiology, King's College Hospital NHS Foundation Trust, London SE5 9RS, UK; philip.maccarthy{at}nhs.net

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Learning objectives

  • To understand the impact of the COVID-19 pandemic on the management of severe aortic stenosis (AS).

  • To appreciate the evidence base supporting transcatheter aortic valve implantation (TAVI) as a treatment for AS.

  • To gain insights into how to select patients for TAVI during the COVID-19 crisis and adapt the AS pathway appropriately.

Introduction

The current COVID-19 outbreak presents an unprecedented challenge to health services worldwide. With the primary goal of reducing the risk of spread of COVID-19, protecting patients and healthcare teams and preserving access to necessary/emergency care, the UK National Health Service (NHS) issued specialty guidance for the management of cardiology patients during this time.1 All hospital trusts were advised early to defer non-urgent cardiovascular diagnostics and interventions and from an early stage, virtually all cardiac surgery ceased, apart from emergency cases. Patient pathways were modified to ensure the highest risk patients could continue to access urgent cardiac care (eg, patients presenting with ST-elevation myocardial infarction (MI)). The underlying aim was to ensure that emergency services remained resilient throughout what was then an unknown onslaught. This guidance was tailored to subspecialty areas including heart failure, arrhythmia, coronary disease and valvular heart disease, in particular the management of aortic stenosis (AS).

AS is common and affects patient groups particularly vulnerable to a poor outcome with COVID-19 infection, with an overall prevalence of clinically significant AS in those greater than 70 years approximately 1%–3%.2 Severe, symptomatic AS has a uniformly poor prognosis, with an estimated 1-year mortality of up to 40%,3 worse than many metastatic cancers. No medical therapy influences outcome, and the only available prognostic treatment is valve replacement/implantation.4 While surgical valve replacement (sAVR) was the treatment of choice for decades, transcatheter aortic valve implantation (TAVI) has become an increasingly safe and effective treatment option in patients at …

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