Ongoing transcatheter aortic valve implantation (TAVI) practice amidst a global COVID-19 crisis: nurse-led analgesia for transfemoral TAVI

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.

Nursing assistance in COVID-19 cardiovascular complications: Integrative Literature Review

“…If left untreated, the symptomatic of severe aortic stenosis has a poor prognosis. [20] The current COVID-19 crisis has led to an unavailability of anesthetic support for non-acute cardiac care. In current practice, transfemoral (TF) TAVI is predominantly performed as an elective procedure in the catheterization laboratory.…”

“…Through this study, the safety and viability of TF-TAVI performed by nurses through local analgesia was demonstrated, possibly eliminating the need for an anesthesiologist present in the catheterization laboratory. [20] However, the nursing program should preferably be started with a good risk for evaluation, training, planning and evaluation. The procedures were performed in a tertiary cardiac center with extensive experience and with all the necessary equipment (such as echocardiography machine and peripheral devices for left ventricular support), experienced staff and an operating room available on demand.…”

“…The procedures were performed in a tertiary cardiac center with extensive experience and with all the necessary equipment (such as echocardiography machine and peripheral devices for left ventricular support), experienced staff and an operating room available on demand. [20] TF-TAVI with analgesia conducted by nurses will evidently facilitate the planning of procedures in a more agile way, thus shortening the potentially dangerous waiting list for the procedure in regular clinical care. During the global crisis of COVID-19, this strategy can allow continuous treatment of TAVI and therefore can prevent deaths unrelated to COVID-19.…”

Dutch cardiology residents and the COVID-19 pandemic: Every little thing counts in a crisis

“…Moreover, the efforts of cardiologists who were involved in tasks that are normally performed by residents increased flexibility and warranted continuation of regular (acute) care. Once again, the healthcare system proves to be an efficient engine that depends on a great team effort of, but not limited to, technicians, nurses, facility services, security personnel, pharmacists and stretcher-bearers [ 3 ].…”

The Netherlands Heart Journal: special issue on COVID-19

“…In addition, they describe the potential negative influence of public health measures on lifestyle behaviour and general well-being. As we need to find a way to continue regular cardiac care amidst this crisis, Vendrik et al [9] propose a means of enabling ongoing transfemoral transcatheter aortic valve implantation (TF-TAVI). TF-TAVI in current practice is predominantly performed as an elective catheterisation laboratory procedure, and the COVID-19 crisis has created a relative unavailability of anaesthesiological support.…”