Heart Valve Procedures in a COVID-19 World: Here are the Facts

At the height of the COVID-19 shutdown, a frail, 93-year-old man needed a complex aortic valve replacement to survive. Physicians at Miami Cardiac & Vascular Institute didn’t hesitate. They performed the procedure and the patient returned to his home in Palm Beach the following day.

Throughout the pandemic, the Institute remained open, caring for the most critically ill.  If a life was threatened by a heart ailment, doctors got to work on critical heart valve surgeries and procedures: Transcatheter aortic valve replacements (TAVR); mitral valve repairs; valvuloplasties; urgent left atrial appendage closures; and complex coronary interventions.

Nationwide,elective surgeries were postponed initially to ensure hospital systems weren’toverwhelmed by the needs of COVID-19 patients, that they had enough criticalcare beds and employees, that there were adequate blood supplies, and to reducethe spread of the virus. Now, doctors want to reassure patients that it’s safe― and important ― to make an appointment if they were among those who postponeda procedure or delayed getting care.

“The fact is that we have never been overwhelmed here. We are fully staffed. We have extensive precautions in place, and we test every patient before a procedure,” said Ramon Quesada, M.D., medical director of Structural Heart and Complex Percutaneous Coronary Intervention at Miami Cardiac & Vascular Institute. “Those with existing heart problems are more at risk of dying from the heart condition than they are from COVID-19.”

Data alsoshows that among those who contract COVID-19, people with heart disease andother underlying health conditions tend to get sicker, suffer more seriouscomplications and have fatal outcomes more often than patients who are healthybefore getting COVID-19. In addition, physicians discovered more recently thatthis particular coronavirus can attack the heart and other organs, not just thelungs as first suspected.

Dr. Quesadais particularly worried about delays in care for those with heart valveproblems because the condition can worsen if not treated. Some patients remainstable for many years and find symptom relief through medical therapy. Othersprogress to more severe symptoms, including shortness of breath, dizziness and fatigue,chest pain or an irregular heartbeat that will require surgical orinterventional procedures.

“Weunderstand that people have concerns about coming to the hospital right now,”Dr. Quesada said. “And some, particularly our international patients, simplycan’t get to us, even now. We do many of our visits through telemedicine.Patients want to see our faces, our expression, our eyes. A phone call is notenough.” For video and audio visits, physicians use the virtual platformBaptist Health Care On Demand, as well as Skype, Zoom, Facetime and othermechanisms.

When surgeryor another intervention is necessary, Dr. Quesada said he reminds patients ofthe safety precautions that are in place at Miami Cardiac & VascularInstitute, including mandatory face masks for all, special cleaning procedures,social distancing and more.

TheInstitute is known for pioneering less invasive procedures. “During COVID-19,which can aggravate the inflammatory response, it’s especially important to useless invasive techniques, when possible,” Dr. Quesada said. Less invasiveprocedures typically require shorter hospitalizations and an easier recoverythan open procedures.

That was thecase with the 93-year-old man from Palm Beach, who required a complex combinationof techniques. Immediately before the heart valve replacement (actually avalve-in-valve procedure to fix a valve placed years earlier), the patientunderwent BASILICA. It’s a new procedure to lacerate the original valve leafletso that it won’t later obstruct the blood flow in the coronary artery, acomplication that can be deadly. The separation allows the new valve to openproperly when it is placed.

Everythingwas able to be done through tiny incisions. “He’s doing very well now,” Dr.Quesada said.

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With internationally renowned centers of excellence, 12 hospitals, more than 27,000 employees, 4,000 physicians and 200 outpatient centers, urgent care facilities and physician practices spanning across Miami-Dade, Monroe, Broward and Palm Beach counties, Baptist Health is an anchor institution of the South Florida communities we serve.

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