Expanding use of faster TAVI procedure for AS could eliminate cardiac surgery backlog – Critical Care

Image: Heart surgery backlog needs urgent action, new study finds (Photo courtesy of Pexels)

Aortic stenosis (AS) develops when the aortic valve of the heart narrows, which restricts blood flow out of the heart. The traditional treatment for AS is to replace the narrowed valve, most commonly with open-heart surgery (surgical aortic valve replacement, SAVR). But transcatheter aortic valve implantation (TAVI), which is a new keyhole procedure, is being used more and more and is now recommended for patients aged 75 and over. Prompt treatment is vital for people diagnosed with severe AS, as around 50% will die within two years of the onset of symptoms. However, the COVID-19 pandemic has caused thousands of cardiac procedures to be postponed and waiting lists to be registered. Now, an international team of researchers has found that converting some of the procedures from SAVR to TAVI would help eliminate the heart surgery backlog.

Researchers from the University of Leeds (West Yorkshire, UK) have warned that inaction could lead to the deaths of thousands of people while waiting for treatment for AS and that urgent action is needed to clear the backlog people waiting for life-saving treatment. Previous work estimated that 4,989 people in the UK with severe AS missed life-saving treatment between March and November 2020. The researchers modeled the potential impact on waiting lists of increased treatment capacity as well than using the faster and less invasive treatment. TAVI procedure. Even in the best-case scenario, they found that the waiting list would take nearly a year to disappear and more than 700 people would die while waiting for treatment.

Researchers studied the impact that increasing processing capacity and converting some operations to the faster TAVI procedure would have on the backlog. They found that the best and most feasible option involved a combination of increasing capacity by 20% and converting 40% of procedures from SAVR to TAVI. This would clear the backlog in 343 days, with 784 deaths while people wait for treatment. The team wants to see greater collaboration at local and national levels to agree on needed changes that can ensure people with severe AS receive crucial treatment as quickly as possible.

“During the COVID-19 pandemic, there has been a sharp drop in procedures used to treat severe aortic stenosis. In our study, we found that without a combination of increased capacity to treat patients with severe AS and expanded use of TAVI, there would be many potentially preventable deaths during the post recovery period. -COVID-19,” said Professor Chris Gale, Professor of Cardiovascular Medicine at the Medical School and co-director of the Leeds Institute for Data Analytics. “It’s the only option that will prevent the deaths of thousands of people with untreated aortic stenosis.”

“Before the pandemic, around 13,500 SAVR and TAVI procedures were performed each year across the UK. Increasing capacity by 20% would mean one or two additional TAVI procedures each week per centre,” added Professor Mamas Mamas, Professor of Cardiology at Keele University and Consultant Cardiologist at University Hospitals of North Midlands NHS Trust, who was l one of the principal investigators of the study. .

Related links:
University of Leeds

Comments are closed.