Lessons for Treating Structural Heart Patients during the COVID-19 Pandemic and Beyond

ABSTRACT

Background

We sought to compare characteristics and outcomes of structural heart disease (SHD) patients treated during the regional peak of the Coronavirus Disease 2019 (COVID-19) pandemic (“COVID era”) compared with historical controls. During the COVID era, elective SHD procedures at Beth Israel Deaconess Medical Center were canceled but urgent cases were still performed. We enacted several practice changes in an effort to minimize complications, prevent COVID transmission, and decrease hospital stay during the pandemic.

Methods

Baseline characteristics and outcomes were collected on all patients who underwent SHD procedures during the COVID era and compared with patients treated during the same time period in 2019.

Results

Compared with SHD patients treated during 2019 (N = 259), those treated during the COVID era (N = 26) had higher left ventricular end diastolic pressure (LVEDP; 28 vs. 21 mmHg, p = 0.001), and were more likely New York Heart Association class IV (26.9% vs. 10.0%, p = 0.019), but had a lower rate of bleeding/vascular complications (0% vs. 16.2%, p = 0.013), a lower rate of permanent pacemaker implantation (0% vs. 17.4%, p = 0.019), and a greater proportion of patients were discharged on post-operative day 1 (POD#1; 68.2% vs. 22.2%, p < 0.001).

Conclusion

Practice changes employed for patients treated during the COVID era were associated with fewer vascular complications, a greater proportion of patients discharged on POD#1, and a lower rate of pacemaker implantation despite more severe illness. As a result, we plan to continue these practices in the post-COVID era.

Key Words:

• TAVR
• mitral valve repair
• structural heart
• COVID-19

Disclosure statement

Mark Tuttle, Marie-France Poulin, Kalon Ho, Abel Casso-Dominguez, Kim Guibone, Ravi Sharma: No conflicts of interest to disclose. Duane Pinto: Receives consulting fees from Abiomed, AbbottVascular, Boston Scientific, Magenta, Medtronic, NuPulseCV, and Teleflex. Roger Laham: Receives proctoring fees from Edwards and Medtronic.

Supplementary material

Supplemental data for this article can be accessed on the publisher’s website

Additional information

Funding

The authors have no funding to report.