Delaying Valve Replacement During COVID-19 can be Deadly

Patients with severe aortic stenosis should undergo valve replacement surgery within 2 weeks. This results in better clinical outcomes if patients are infected by coronavirus in future.

Multicenter International Valve Disease Registry’s study has shown poor treatment outcomes in hospitalized COVID-19 patients with uncorrected valve disease.

There was a huge increase in mortality rate 30 days post-hospital admission in COVID patients with underlying valvular disease. The study suggests that patients who suffer from aortic stenosis should undergo valve replacement without any delay.

Coronavirus
Coronaviruses infect animals, humans, and birds. Human coronaviruses, such as SARS, MERS, and 2019-nCoV cause respiratory distress and even death. The S protein is the infectious agent of the virus.

‘Patients with severe aortic stenosis should undergo a valve replacement within 2 weeks. This has better clinical outcomes if the patient is infected by Coronavirus in the future. The chances of clinical improvement & survival are greater in such patients. On the contrary, patients with underlying heart valve disease and COVID 19 have poor treatment outcomes that may lead to complications including death.’

Due to the COVID-19 outbreak, it is seen that doctors are postponing their elective surgeries in various parts of the world. The urgent and routine care for non-COVID patients has been interrupted. One of these is the valve replacement surgery in patients with aortic stenosis (narrowing of the valve in the large blood vessel branching off the heart).

A recent study demonstrates that physicians should refrain from postponing such surgeries. The valve replacement should be carried out as soon as possible by using all the personal protective equipment (PPE).

Each healthcare worker present in the operation theatre must be provided PPE. This procedure can be carried out by taking all the precautions, as mentioned in the standard operating procedures.

Aortic Valve Stenosis - Causes - Symptoms - Diagnosis - Replacement
Aortic valve Stenosis is an abnormal narrowing of the c valve. Symptoms include angina, and that of heart failure. Aortic valve replacement is effective therapy.

For patients with heart valve disease - close monitoring, timely repair or replacement of the heart valves are essential. Although the whole world is undergoing the unlocking phase, it has become very difficult for everyone to return to their normal work routine.

In many countries, it is seen that teleconsultation is still preferred over face-to–face consultation. This has a major drawback as echocardiography (produces live images of the heart) for patients with underlying heart diseases is not possible through teleconsultation.

Mitral Valve Disease and Replacement
Slide and animation on ‘Mitral Valve Disease and Replacement’ describing the anatomy, function of the valve and its replacement with an artificial one.

Apart from this, there is a delay in the planned intervention due to the ongoing pandemic as the capacity of the catheterization laboratory and operation theatres have decreased significantly.

Irrespective of the valve disease, the most important indicator for a valve replacement is the onset of symptoms in patients. Patients who are asymptomatic and have normal cardiac function can have a regular follow up at the clinic.

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The symptomatic patients should be prioritized for a review, and a detailed history should be taken. The patients with aortic stenosis showing cavity dilatation or fall in ejection fraction below accepted thresholds should also be prioritized for valvular intervention.

Delaying the valve replacement is associated with death while awaiting the surgery or impaired survival rates after the surgery. Due to the pandemic, there is prolonged waiting period before the surgery, patients with Heart failure ( stage III & IV), impaired left ventricular function (left ventricular ejection fraction < 50 % ), syncope are on the top of the priority list & their surgery should be carried out within two weeks to have better clinical outcomes.

Patients with severe mitral valve regurgitation (back flow of blood as the valve of the heart does not close tightly) may not need an immediate intervention if they are asymptomatic & left ventricular function is near the normal ranges. A teleconsultation once in 6-9 months is recommended during this pandemic.

The study summarizes that valve replacement surgeries are doable even during such difficult times of the pandemic. If the valve replacement is done at the right time, there are better clinical outcomes.

On the contrary, patients with an underlying untreated heart valve disorder infected with coronavirus become very unstable leading to complications including death. Hence patients with severe aortic stenosis should not delay their surgical procedure.

Source-Medindia