How COVID-related delays are impacting TAVR patients

In March 2020, an executive order went into effect that forced hospitals throughout the state of New York to delay elective procedures. The decision, made as an attempt to limit the spread of COVID-19, resulted in the delay of transcatheter aortic calve replacement (TAVR) procedures for a significant number of patients.

Researchers have now evaluated how that delay impacted TAVR patients at one New York tertiary care hospital, sharing their findings in JAMA Network Open.

Overall, 77 patients with severe aortic stenosis were originally scheduled to undergo TAVR when the executive order was announced on March 23, 2020. Nearly 29% of those patients had diagnostic tests or heart team appointments canceled, and 10% of patients experienced a cardiac event—defined as either the need for urgent TAVR or death—within a month of the executive order. That included six patients who needed urgent TAVR and two that died.

Patients experiencing a cardiac event, the authors found, had “significantly lower” left ventricular ejection fraction and a higher rate of obstructive coronary artery disease.

The research team then looked beyond a month, tracking outcomes all the way to June 6, 2020, when TAVR procedures were able to resume. From March 23 to June 6, 35% of those original 77 patients had experienced a cardiac event. Of those patients, 24 required urgent TAVR and three died. They were more likely to have a history of a cerebrovascular accident, and their left ventricular ejection fraction was “slightly lower” than other patients awaiting TAVR.

Prior to March 2020, the team emphasized, no patients at the tertiary care hospital had ever died while waiting to undergo TAVR.

“Patients with advanced symptoms, lower left ventricular ejection fraction, obstructive coronary artery disease, and cerebrovascular accident history represent a high-risk population with AS, and the heart team should consider these factors for earlier access to TAVR during the COVID-19 pandemic,” concluded lead author Richard Ro, MD, of Mount Sinai Hospital in New  York City, and colleagues.

The full research letter from Ro et al. is available here.