key: cord-0691999-5i5t9ogm
authors: Mehta, Jeet J.; Patel, Jaymin; Ayoub, Bassam; Mohanty, Bibhu D.
title: Caution regarding potential changes in AVR practices during the COVID‐19 pandemic
date: 2020-05-04
journal: J Card Surg
DOI: 10.1111/jocs.14602
sha: d7f98cb2ebdca94c79a09f18f6398e827bbbb601
doc_id: 691999
cord_uid: 5i5t9ogm

To improve resource allocation in face of the COVID‐19 pandemic, hospitals around the country are restricting the performance of elective surgery to preserve ventilators, operating rooms, ICU beds and protect anesthesiologists. For patients with severe aortic stenosis, efforts to bring treatment to symptomatic patients amid this pandemic might lead to favored use of catheter based management using minimalist techniques that do not require these elements. In this context, some patients with well tested surgical indications for valve replacement may be treated by catheter‐based methods. It is important that outcomes for these cases are followed closely both at respective sites and in national registries. As we recover from this pandemic, surgical cases should once again be driven by multi‐disciplinary discussion and clinical trial data, and not a mentality of crisis management.

anesthesiologists. For patients with severe aortic stenosis, efforts to bring treatment to symptomatic patients amid this pandemic might lead to favored use of catheter based management using minimalist techniques that do not require these elements. In this context, some patients with well tested surgical indications for valve replacement may be treated by catheter-based methods. It is important that outcomes for these cases are followed closely both at respective sites and in national registries. As we recover from this pandemic, surgical cases should once again be driven by multi-disciplinary discussion and clinical trial data, and not a mentality of crisis management. be performed without them-using widely described "minimalist" methodology. 6 Bolstered by the recent expansion of TAVR to include low society of thoracic surgery risk AS patients, there may be a tendency towards catheter-based treatment in symptomatic patients even during the COVID-19 pandemic. 7, 8 However, we must understand that transcatheter therapy has specific limitations when compared to surgical AVR (SAVR) and acknowledge that SAVR remains the standard in specific patient populations. This includes patients with bicuspid valve stenosis, aneurysmal disease of the ascending aorta, small aortic roots and annuli, isolated aortic regurgitation or noncalcified valve disease, low coronary heights, multivessel coronary disease or those who are young enough to be better candidates for mechanical prostheses. 9 Many of these patients were excluded from clinical trials for TAVR. However, given the desire to treat patients, address symptoms, and modify the course of morbidity-without resource use or hazard-patients with these features may preferentially be treated with TAVR during this time.

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