Modeling the impact of delaying transcatheter aortic valve replacement for the treatment of aortic stenosis in the era of COVID-19.

Autor:	Freno DR; Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tenn., Shipe ME; Department of General Surgery, Vanderbilt University Medical Center, Nashville, Tenn., Levack MM; Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tenn., Shah AS; Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tenn., Deppen SA; Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tenn.; Tennessee Valley Healthcare System, Department of Surgery, Nashville, Tenn., O'Leary JM; Department of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tenn., Grogan EL; Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tenn.; Tennessee Valley Healthcare System, Department of Surgery, Nashville, Tenn.
Jazyk:	angličtina
Zdroj:	JTCVS open [JTCVS Open] 2021 Sep; Vol. 7, pp. 63-71. Date of Electronic Publication: 2021 Jun 08.
DOI:	10.1016/j.xjon.2021.06.006
Abstrakt:	Objective: The aim of this study was to model the short term and 2-year overall survival (OS) for intermediate-risk and low-risk patients with severe symptomatic aortic stenosis (AS) undergoing timely or delayed transcatheter aortic valve replacement (TAVR) during the 2019 novel coronavirus (COVID-19) pandemic. Methods: We developed a decision analysis model to evaluate 2 treatment strategies for both low-risk and intermediate-risk patients with AS during the COVID-19 novel coronavirus pandemic. Results: Prompt TAVR resulted in improved 2-year OS compared with delayed intervention for intermediate-risk patients (0.81 vs 0.67) and low-risk patients (0.95 vs 0.85), owing to the risk of death or the need for urgent/emergent TAVR in the waiting period. However, if the probability of acquiring COVID-19 novel coronavirus is >55% (intermediate-risk patients) or 47% (low-risk patients), delayed TAVR is favored over prompt intervention (0.66 vs 0.67 for intermediate risk; 0.84 vs 0.85 for low risk). Conclusions: Prompt transcatheter aortic valve replacement for both intermediate-risk and low-risk patients with symptomatic severe AS results in improved 2-year survival when local healthcare system resources are not significantly constrained by the COVID-19. (© 2021 The Authors. Published by Elsevier Inc. on behalf of The American Association for Thoracic Surgery.)
Databáze:	MEDLINE
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