key: cord-0910665-ivcee8l2
authors: Li, Wilson W.L.; van Garsse, Leen A.F.M.; van Wely, Marleen H.; Morshuis, Wim J.; van Royen, Niels
title: Performing Structural Heart Disease Interventions During the Coronavirus Disease 2019 (COVID-19) Pandemic – But What Are the Downsides?
date: 2020-05-12
journal: JACC Cardiovasc Interv
DOI: 10.1016/j.jcin.2020.05.007
sha: f925f7b88af1f8bb2c590cbf2d7a92509a41b3c9
doc_id: 910665
cord_uid: ivcee8l2

nan

Angiography and Interventions consensus statement on triage considerations for patients referred for structural heart disease (SHD) intervention during the current coronavirus disease 2019 (COVID-19) pandemic by Shah et al (1) . The paper provides useful guidance regarding triage and timing of interventions for patients awaiting SHD treatment during this global crisis. However, we believe the possible downsides of performing (high-risk) cardiovascular interventions during this period require additional discussion. These considerations should be more explicitly incorporated in any framework addressing interventions during the COVID-19 pandemic.

It is clear, that time is not a luxury most patients with symptomatic cardiovascular diseases can afford, especially regarding SHD. For inpatients who cannot be discharged due to medical reasons, it is rational to perform necessary interventions during the COVID-19 pandemic, analogous to recommendations from the consensus statement (1). Conversely, for outpatients, risks for sudden cardiac death or irreversible cardiac deterioration while awaiting intervention should be weighed against the risks of nosocomial COVID-19 exposure and associated morbidity and mortality. Although the chances of nosocomial COVID-19 transmission in this setting are largely unknown and are being investigated (2), the possibility is factual and well reported (3, 4) .

Furthermore, the phenomenon of asymptomatic carriers of COVID-19 has become increasingly important, inciting an absolute (but still unmeasurable) risk that COVID-19 positive patients, albeit without any symptoms, will undergo high-risk cardiovascular interventions. While it is uncertain how COVID-19 will influence the periprocedural period, these cardiovascular patients commonly share similar risk factors (i.e. elderly patients with preexisting concurrent cerebrovascular conditions, diabetes, chronic kidney diseases) as patients who have the highest risks for mortality after being hospitalized for COVID-19 pneumonia (5) .

Unfortunately, there is currently insufficient data available to properly guide us in this difficult balancing act. Updated regional and national epidemiologic data on COVID-19 prevalence are sorely needed. Moreover, we eagerly await further reports with case series detailing selection criteria, outcome data and risks of nosocomial COVID-19 transmission for (out)patients undergoing cardiovascular interventions during this pandemic. Also, the expansion and improvement of testing to identify asymptomatic COVID-19 carriers will be crucial for optimal case selection. Until then, the dilemma of choosing the lesser evil will remain a challenge for the clinician and the patient on a daily basis.

from the American College of Cardiology (ACC) and the Society for Cardiovascular Angiography and Interventions (SCAI)

COVID-19) Pandemic: An ACC /SCAI Consensus Statement

COVID-19 -Multicenter Study on Nosocomial Transmission of SARS-CoV-2 Virus (NOSO-COR)

Clinical and Transmission Characteristics of Covid-19 -A Retrospective Study of 25 Cases From a Single Thoracic Surgery Department

First Reported Nosocomial Outbreak of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in a Pediatric Dialysis Unit

Comorbidity and Its Impact on 1590 Patients With Covid-19 in China: A Nationwide Analysis