Abstract
The current coronavirus disease 2019 (COVID-19) crisis has led to a relative unavailability of anaesthesiological support for non-acute cardiac care. Currently, transfemoral transcatheter aortic valve implantation (TF-TAVI) is predominantly performed as an elective catheterisation laboratory (cath lab) procedure. Hence, the performance of TAVI could come to a halt amidst the COVID-19 crisis. Our study population comprised 90 patients treated with TF-TAVI, with local analgesia performed by our dedicated cath lab nurses. The patients had a mean age of 80 ± 5 years and 59% were male, with a predicted surgical risk of 2.2 ± 0.9/3.1 ± 2.4% (Society of Thoracic Surgeons Predicted Risk of Mortality [STS-PROM] score/EuroSCORE II), depicting a contemporary, lower-risk population. The composite endpoint of device success (Valve Academic Research Consortium [VARC]-2) was reached in all patients. No patients showed more than mild paravalvular leakage (3/90, 3.3%). Overall, intravenous medication was sparsely used during the procedure, with 48 of the 90 (53%) patients receiving no unplanned intravenous medication. There was neither procedural nor in-hospital mortality. The performance of TF-TAVI using local analgesia only, managed by a dedicated nurse instead of an anaesthesiologist, was shown to be feasible and safe in a selected group of patients. This strategy may (temporarily) eliminate the need for an anaesthesiologist to be present in the cath lab and enables ongoing TAVI treatment amidst the global COVID-19 crisis.
Highlights
Transcatheter aortic valve implantation (TAVI) is a well-established treatment for aortic valve stenosis which has been widely adopted and has evolved into a minimalistic, relatively low-risk procedure for the majority of patients
The current COVID-19 crisis has led to a relative unavailability of anaesthesiological support for nonacute cardiac care
We aim to show the safety and feasibility of transfemoral transcatheter aortic valve implantation (TF-TAVI) with nurseled local analgesia, possibly eliminating the need for an anaesthesiologist to be present in the cath lab
Summary
Transcatheter aortic valve implantation (TAVI) is a well-established treatment for aortic valve stenosis which has been widely adopted and has evolved into a minimalistic, relatively low-risk procedure for the majority of patients. Instead of conscious sedation or general anaesthesia, minimalises the invasive nature of the procedure and has been shown to lower the incidence of postoperative delirium and to decrease the duration of hospitalisation [1,2,3]. The current COVID-19 crisis has led to a relative unavailability of anaesthesiological support for nonacute cardiac care. Transfemoral (TF)-TAVI is predominantly performed as an elective catheterisation laboratory (cath lab) procedure. The performance of TAVI could come to a halt amidst the COVID-19 crisis. We aim to show the safety and feasibility of TF-TAVI with nurseled local analgesia, possibly eliminating the need for an anaesthesiologist to be present in the cath lab
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