Transcatheter aortic valve implantation (TAVI) procedures were more acutely impacted during the first two years of the COVID-19 pandemic in countries in Central-South America, Africa and Asia than in North America and Europe, data published in JACC: Cardiovascular Interventions have shown.
Author Xavier Armario (Galway University, Galway, Ireland) reported the registry data from 130 centres in 61 countries, spanning six continents, assessing the impact of COVID-19 on TAVI activity globally.
“We know COVID-19 had a huge impact all over the world, not only in healthcare, but also in social and economic issues,” Armario said of the data. “We know that it had a negative impact on cardiovascular care. For example, hospital admission for acute coronary syndromes and STEMI [ST-segment elevation myocardial infarction] pathways activation were reduced, but there are not much data regarding the global impact on patients with valvular heart disease and a specific procedure such as TAVI.”
According to Armario, the research is among the first such projects to chart the international impact of the pandemic on TAVI volumes. “We know patients with symptomatic severe aortic valve stenosis have a bad prognosis if they are not treated with SAVR [surgical aortic valve replacement] or TAVI,” he said. “A treatment deferral is associated with an increased risk of hospitalisation and death.”
The data collected and published by Armario and colleagues include 65,980 TAVI procedures spanning from January 2018 to December 2021. The analysis took into account factors including geographic region, national socioeconomic data, and sought to understand the links between the severity of COVID-19 incidence and public health responses to the pandemic, assessing as a primary endpoint, the monthly variation in the average number of TAVI cases per centre performed between January 2018 and December 2021.
The publication reports that the first and second pandemic waves were associated with a significant reduction of 15% and 7% respectively in monthly TAVI case volume, compared with the pre-pandemic period. The third pandemic wave, however, was not associated with a reduction in TAVI activities.
A greater reduction in TAVI activity was observed in Africa (falling by 52%), Central-South America (falling by 33%), and Asia (falling by 29%), while private hospitals, urban areas, low-volume centres, countries with lower development, higher COVID-19 incidence, and more stringent public health restrictions saw the greatest reduction in TAVI activity.
“The magnitude of the reduction in TAVI volume during the first pandemic wave was modest overall, but it was much more profound in Africa, Central-South America, and Asia,” Armario and colleagues write. “These findings are in line with a lower impact on ST-segment elevation myocardial infarction activity reported across North America and Europe during the COVID-19 pandemic.
“While several factors could influence this observation, many countries in these regions have both low development and economic statuses. Supporting this hypothesis, we observed a clear association between the TAVI volume reduction in the first pandemic wave and the national HDI [development status] and GDP/GNI [gross domestic product/gross national income] per capita.”
Armario presented an initial summary of the data at PCR London Valves 2022 (27–29 November, London, UK).
