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Effect SARS-COV-2 on Cases of Transcatheter Aortic Valve Implantation

      The effect of SARS-COV-2 diagnosis on cases of aortic stenosis that requires a transcatheter aortic valve implantation (TAVI) is poorly understood, and the long-term effects are not well reported. The researchers aimed to determine whether there exists a difference in all-cause mortality between patients with a SARS-COV-2 diagnosis that received a TAVI compared with those that did not contract SARS-COV-2.
      The researchers queried the TriNetX database, a COVID-19 research network of 61 health care organizations. They analyzed the data using the ICD 10 codes used for TAVI procedures from January 20, 2020 to January 30, 2021, and identified 3,075 patients aged 18 to 90 between the two groups: 224 SARS-COV-2 TAVI and 2,851 non-SARS-COV-2 TAVI patients. Descriptive statistics were used to measure association, and the Kaplan-Meier survival curve was used to assess the end points of mortality. A propensity score matching of 1:1 was performed with the covariates (i.e., age, male, female, hypertension, coronary artery disease, heart failure, diabetes, smoking history, chronic obstructive pulmonary disease, and body mass index < 30) to reduce possible differences, which resulted in a matched cohort (n = 224/224) over a 365-day time frame. Adjusted hazard ratios of mortality were compared by SAR-COV-2 diagnosis using the Cox proportional hazards model.
      The researchers identified 3,075 patients aged 18 to 90 with comparable ages between the two groups (77.1± 9.26 vs 76.9 ± 8.94; p = 0.65). Compared to the non-SARS-COV-2 TAVI group, the SARS-COV-2 TAVI group had higher baseline co-morbidities, including hypertension (95.9% vs 76.1%; p < 0.01), coronary artery disease (88.8% vs 66.8%; p < 0.01), heart failure (86.1% vs 47.0%; p < 0.01), diabetes (65.1% vs 35.4%; p < 0.01), smoking history (50.4% vs 29.4%; p < 0.01), chronic obstructive pulmonary disease (38.3% vs 16.8%; p < 0.01), and body mass index < 30 (66.5% vs. 40.7%; p < 0.01). A log rank test illustrated that the SARS-COV-2 TAVI group had a lower survival probability at end of time window compared with the non-SARS-COV-2 TAVI group (70.7% vs 92.9%; p < 0.01; see Figure 1). A hazards ratio further verified the results (9.8, p < 0.02).
      Figure 1
      Figure 1Kaplan-Meier, SARS-COV-2 TAVI cohort/non-SARS-COV-2 cohort.
      Patients in the SARS-COV-2 TAVI group seemed to have higher all-cause mortality in the unmatched and matched groups than those in the non-SARS-COV-2 TAVI group based on the log rank test. The SARS-COV-2 TAVI group also had a high prevalence of hypertension, coronary artery disease, heart failure, diabetes, smoking history, chronic obstructive pulmonary disease, and body mass index < 30. The potential effect of SARS-COV-2 on TAVI cases is still poorly understand and potential long-term consequences need to be further explored. A recent study suggested that whenever possible, surgery should be delayed for at least 7 weeks following SARS-CoV-2 infection [Timing of surgery following SARS‐CoV‐2 infection: an international prospective cohort study].
      COVIDSurg Collaborative, & GlobalSurg Collaborative
      Timing of surgery following SARS-CoV-2 infection: an international prospective cohort study.
      The decision to delay TAVI should be tailored for each patient, factoring possible advantages of delaying TAVI after SARS-CoV-2 infection versus potential risks of delay. However, there is a need for further prospective studies to define optimal timing for TAVI after SARS-CoV-2 infection to minimize adverse outcomes as reported in our analysis.

      Disclosures

      The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

      References

        • COVIDSurg Collaborative, & GlobalSurg Collaborative
        Timing of surgery following SARS-CoV-2 infection: an international prospective cohort study.
        Anaesthesia. 2021; (Advance online publication)https://doi.org/10.1111/anae.15458