key: cord-0871396-fzocc3vr
authors: Cereda, Alberto; Cugola, Diego; Balestrieri, Giulio; Vassileva, Angelina; Valsecchi, Orazio
title: Unexpected peak of mortality: The COVID-19 burden on Bergamo transcatheter aortic valve implantation registry
date: 2020-09-03
journal: Anatol J Cardiol
DOI: 10.14744/anatoljcardiol.2020.01955
sha: 6763157fda54ad15731fcaadd66bd5a01762794d
doc_id: 871396
cord_uid: fzocc3vr

nan

To the Editor,

The coronavirus disease 2019 (COVID-19) outbreak has overwhelmed Northern Italy, just like rest of the world. The province of Bergamo has been one of the hardest-hit areas in Northern Italy since the beginning of COVID-19 epidemic (1) . The ''ASST Papa Giovanni XXIII" public hospital is a tertiary reference center for cardiovascular diseases throughout the region of Northern Italy. It is highly specialized for the treatment of valve diseases. In the most critical phases of the epidemic, outpatient visits and non-urgent health services were suspended; however, the cardiovascular emergency network was kept active (2) . Patients un-dergoing transcatheter aortic valve implantation (TAVI) are notoriously frail and exposed to the risk of COVID-19 infection. These patients are mostly affected by the absence of cardiac outpatient follow-up. Methods: We wanted to evaluate the outcomes of our patients who underwent TAVI from 2010 to the end of April 2020 in the Bergamo TAVI registry that is characterized by an annual mortality rate of around 10% with an overall five-year survival of over 50% (Fig. 1) . Table 1 shows the general characteristics of this population. From January 2010 to April 2020, we obtained the monthly mortality rate (by dividing the number of patients who died in each month by the total number of live patients in the follow-up period). Results: We observed a peak incidence of annual and monthly mortality in the COVID-19 period (from January 2020 to April 2020) that cannot be otherwise explained. The 20 patients who died during the COVID-19 period as compared with the 106 patients who died in the non-COVID period did not differ significantly in the clinical risk profile. The monthly mortality incidence rate was eight times higher during the months of the COVID-19 period (6.6% in the COVID-19 period versus an average monthly mortality incidence value of 0.82% in the non-COVID pe- The second column shows the characteristics of patients who died during the follow-up from 2010 to 2020. The third column reports the characteristics of patients who died during the COVID-19 epidemic. The fourth column indicates the statistical differences between the deceased patients in the standard follow-up and patients in the follow-up during the COVID-19 period riod). A telephonic follow-up revealed that most of the deceased patients reported the onset of fever, dyspnea, and sudden death during the following days after undergoing TAVI. The data, although preliminary and monocentric, consider all the possible biases and propose the need for more extensive population studies to confirm or deny at least three considerations of this study. Because of their clinical profiles, patients who have undergone TAVI are particularly fragile and presumably vulnerable to COV-ID-19 infection. It is necessary to understand how to better protect this population for which significant medical and technological resources have been largely invested. It will be essential to comprehend which subgroups of patients who underwent TAVI are most affected by a viral infection and further clarify the cardiovascular predisposition toward a less favorable outcome. It is important to understand the impact of this viral epidemic in the various registries and clinical studies where the viral outbreak could affect the results, especially the medium-and long-term ones in the older and more fragile populations. Annual and monthly incidence of mortality. The mortality peak during the COVID-19 outbreak (February-April 2020). The mortality rate was calculated by dividing the number of patients who died by the total number of patients during the follow-up. Patients with postoperative mortality within 30 days were excluded

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