Factors to consider doing differently along the patient pathway for AS during the COVID-19 crisis
Phase of patient pathway | Alterations to practice during the COVID-19 crisis |
Case selection | Review TAVI waiting list and triage for highest risk. |
Review sAVR waiting list. | |
Convert intermediate risk patients to TAVI if appropriate. | |
Convert low-risk patients to TAVI only with Heart Team consensus. | |
Consider risk to patient of nosocomial COVID-19 infection. | |
TAVI work-up | Avoid TOE. |
Use CTCA instead of invasive coronary angiography. | |
Consider risk to patient of COVID-19 when attending for tests. | |
Do all tests in a single attendance. | |
Procedure | Keep it simple. |
Use devices the operator/team is familiar with. | |
Transfemoral procedures only. | |
Consider appropriateness/ethics of surgical bail-out. | |
Post-TAVI | Early safe discharge. |
No need for follow-up echo until 6 months. |
CTCA, CT coronary angiogram; sAVR, surgical valve replacement ; TAVI, transcatheter aortic valve implantation; TOE, transoesophageal echo.