Triage Considerations for Patients Referred for Structural Heart Disease Intervention During the Coronavirus Disease 2019 (COVID-19) Pandemic: An ACC /SCAI Consensus Statement

The COVID-19 pandemic has strained health care resources around the world causing many institutions to curtail or stop elective procedures. This has resulted in the inability to care for patients valvular and structural heart disease (SHD) in a timely fashion potentially placing these patients at increased risk for adverse cardiovascular complications including congestive heart failure and death. The effective triage of these patients has become challenging in the current environment as clinicians have had to weigh the risk of bringing susceptible patients into the hospital environment during the COVID-19 pandemic versus the risk of delaying a needed procedure. In this document, we suggest guidelines as to how to triage patients in need of SHD interventions and provide a framework of how to decide when it may be appropriate to proceed with intervention despite the ongoing pandemic. In particular, we address the triage of patients in need of trans-catheter aortic valve replacement and percutaneous mitral valve repair. We also address procedural issues and considerations for the function of structural heart disease teams during the COVID-19 pandemic

Triage Considerations for Patients Referred for Structural Heart Disease Intervention During the COVID-19 Pandemic: An ACC/SCAI Position Statement

The coronavirus disease-2019 (COVID-19) pandemic has strained health care resources around the world, causing many institutions to curtail or stop elective procedures. This has resulted in an inability to care for patients with valvular and structural heart disease in a timely fashion, potentially placing these patients at increased risk for adverse cardiovascular complications, including CHF and death. The effective triage of these patients has become challenging in the current environment as clinicians have had to weigh the risk of bringing susceptible patients into the hospital environment during the COVID-19 pandemic against the risk of delaying a needed procedure. In this document, the authors suggest guidelines for how to triage patients in need of structural heart disease interventions and provide a framework for how to decide when it may be appropriate to proceed with intervention despite the ongoing pandemic. In particular, the authors address the triage of patients in need of transcatheter aortic valve replacement and percutaneous mitral valve repair. The authors also address procedural issues and considerations for the function of structural heart disease teams during the COVID-19 pandemic

Drug-Eluting Stents in the Management of Coronary Artery Disease: Implications for Payors and Hospitals

Of the >1 million patients who undergo coronary intervention in the US annually, 10-45% develop stent restenosis. Designed to inhibit tissue growth following coronary intervention, the drug-eluting stent (DES) is a breakthrough technology that has been shown to reduce restenosis by 80%, dramatically lowering the percentage of patients requiring repeat intervention. The health-economic implications of DES are complex and depend on the perspective from which they are viewed (i.e. hospital, payor, or physician). For hospitals, DES are a truly disruptive technology. Hospitals are caught between substantially higher costs (DES cost 3-fold more than bare-metal stents), inadequate reimbursement for those higher costs, and potentially declining revenue (fewer bypasses and repeat interventions for restenosis). In contrast, DES appear to be very cost effective for payors. Randomized studies have suggested that the higher initial costs of DES are nearly offset by reduced follow-up costs related to fewer repeat angioplasties and bypass surgeries. Furthermore, overall cost reductions to payors will occur as patients are converted from bypass surgery to multi-vessel coronary intervention with DES. Their high price continues to be a barrier to the use of DES, while the concerns about safety and stent thrombosis have substantially diminished. With greater competition, declining DES prices, and further studies demonstrating safety and efficacy in a wider range of real-world patients, DES will become the default platform for transcatheter coronary intervention in the near future.Coronary-artery-disease, Coronary-stent-thrombosis, Economic-implications, Paclitaxel, Sirolimus

Usefulness of a cobalt chromium coronary stent alloy.

The cobalt chromium Guidant Multi-Link Vision coronary stent was deployed in 267 patients as part of a multicenter international registry. Major adverse cardiovascular events were infrequent, and late (180 days) quantitative angiography demonstrated binary (\u3e50%) in-stent restenosis in 15.7% of patients. This registry establishes the safety and efficacy of this alloy as a coronary stent platform

Transcarotid vs Subclavian/Axillary Access for Transcatheter Aortic Valve Replacement with SAPIEN 3.

BACKGROUND: Subclavian/Axillary (TAx) Access has become the most frequently used alternative access route for Transcatheter Aortic Valve Replacement (TAVR). Transcarotid (TC) TAVR has grown in popularity recently. Comparative data between these two contemporary access methods is lacking. METHODS: Data were extracted from the STS/ACC TVT Registry™ (June 2015 to October 2019) for patients undergoing TAVR via TC or TAx access with the SAPIEN 3 and SAPIEN 3 Ultra transcatheter heart valves. Procedural, index hospitalization, and 30-day outcomes were analyzed for TC vs. TAx groups after 1:2 propensity matching of patient baseline characteristics. RESULTS: 3903 cases were included of which 801 TC and 3102 TAx procedures were compared. After 1:2 propensity matching, TC TAVR was associated with similar 30-day mortality (4.3% vs. 5.2%, P=0.34) but significantly lower risk of stroke (4.2% vs. 7.4%, HR 0.56 [95% CI:0.38-0.83] P=0.003) compared to TAx access. Other outcomes that favored TC over TAx included shorter procedure time (117.0 vs 132.4 min; P CONCLUSIONS: TC TAVR is associated with similar mortality and significant reduction in stroke compared to the subclavian/axillary approach. If femoral access is precluded, TC may be a safe, or at times, preferred avenue of transcatheter valve delivery