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. How to risk-stratify elective surgery during the COVID-19 pandemic? What it really means to cancel elective surgeries: to make room for coronavirus patients, hospitals are delaying procedures that would make major differences in people's lives. The Atlantic The effect of aortic valve replacement on survival Precautions and procedures for coronary and structural cardiac interventions during the COVID-19 pandemic: guidance from canadian association of interventional cardiology Triage considerations for patients referred for structural heart disease intervention during the coronavirus disease 2019 (COVID-19) pandemic: an ACC/SCAI consensus statement The vancouver 3M (multidisciplinary, multimodality, but minimalist) clinical pathway facilitates safe next-day discharge home at low-, medium-, and highvolume transfemoral transcatheter aortic valve replacement centers: the 3M TAVR study Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients Transcatheter aortic-valve replacement with a self-expanding valve in low-risk patients The importance of surgical therapy with expansion of TAVR to low-risk patients