key: cord-0782272-pur8e6o6
authors: Shreenivas, Satya; Choo, Joseph; Answini, Geoffrey; Sarembock, Ian J.; Griffin, Jeff; Smith, J. Michael; Kereiakes, Dean
title: TAVR during the COVID19 Pandemic: The ACC/SCAI Consensus Statement
date: 2020-05-03
journal: JACC. Cardiovascular interventions
DOI: 10.1016/j.jcin.2020.04.053
sha: 47c2c4830387304faac38321b52150a0d307449e
doc_id: 782272
cord_uid: pur8e6o6

nan

We appreciate the guidance provided by the ACC/SCAI consensus statement for structural heart disease intervention during the coronavirus (COVID-19) pandemic. 1 patients. Like many programs, our move away from GA was accompanied by reductions in the incidence of hemodynamic instability, oropharyngeal and laryngeal trauma, post procedure delirium and urinary catheter-related events (trauma / infections). Following MAC, patient recovery was more rapid, ICU admissions were reduced and hospital discharge was earlier.

Faced with the prospect of GA for all TAVR, conversion to nurse anesthesia was made rapidly with one heart team physician assigned to monitoring sedation and hemodynamics.

Lastly, patient perception may impact our ability to provide care. Despite acuity profiling and prioritization, patients may cancel scheduled TAVR procedures. Over the past 3 weeks, of 20 patients profiled as non-elective based on CPG by a multi-disciplinary committee, 6 canceled procedures largely due to fears of contracting COVID-19and family abandonment by restrictive hospital visitation policies. One patient died suddenly after cancelling. Further, deferral for "low acuity" severe AS is not benign. Deferred patients are called weekly by the TAVR coordinator.

Despite this, one patient had sudden death 2 weeks after deferral. Counseling patients as to the consequences of treatment delay, the potential for clinical decompensation and emergency hospital presentation are essential. Assurance that every effort to safely expedite their procedure and hospital stay may be helpful.

Triage considerations for patients referred for structural heart disease intervention during the coronavirus disease 2019 (COVID-19) pandemic: An ACC/SCAI consensus Statement

Clinical Faqs Coronavirus (2019-Ncov) COVID-19