Modeling the impact of delaying transcatheter aortic valve replacement for the treatment of aortic stenosis in the era of COVID-19Central MessagePerspective
Daniel R. Freno, MD,
Maren E. Shipe, MD, MPH,
Melissa M. Levack, MD,
Ashish S. Shah, MD,
Stephen A. Deppen, PhD,
Jared M. O'Leary, MD,
Eric L. Grogan, MD, MPH, FACS
Affiliations
Daniel R. Freno, MD
Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tenn
Maren E. Shipe, MD, MPH
Department of General Surgery, Vanderbilt University Medical Center, Nashville, Tenn
Melissa M. Levack, MD
Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tenn
Ashish S. Shah, MD
Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tenn
Stephen A. Deppen, PhD
Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tenn; Tennessee Valley Healthcare System, Department of Surgery, Nashville, Tenn
Jared M. O'Leary, MD
Department of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tenn
Eric L. Grogan, MD, MPH, FACS
Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tenn; Tennessee Valley Healthcare System, Department of Surgery, Nashville, Tenn; Address for reprints: Eric L. Grogan, MD, MPH, FACS, Department of Thoracic Surgery, 609 Oxford House, 1313 21st Ave South, Nashville, TN 37232.
Objective: The aim of this study was to model the short term and 2-year overall survival (OS) for intermediate-risk and low-risk patients with severe symptomatic aortic stenosis (AS) undergoing timely or delayed transcatheter aortic valve replacement (TAVR) during the 2019 novel coronavirus (COVID-19) pandemic. Methods: We developed a decision analysis model to evaluate 2 treatment strategies for both low-risk and intermediate-risk patients with AS during the COVID-19 novel coronavirus pandemic. Results: Prompt TAVR resulted in improved 2-year OS compared with delayed intervention for intermediate-risk patients (0.81 vs 0.67) and low-risk patients (0.95 vs 0.85), owing to the risk of death or the need for urgent/emergent TAVR in the waiting period. However, if the probability of acquiring COVID-19 novel coronavirus is >55% (intermediate-risk patients) or 47% (low-risk patients), delayed TAVR is favored over prompt intervention (0.66 vs 0.67 for intermediate risk; 0.84 vs 0.85 for low risk). Conclusions: Prompt transcatheter aortic valve replacement for both intermediate-risk and low-risk patients with symptomatic severe AS results in improved 2-year survival when local healthcare system resources are not significantly constrained by the COVID-19.
