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’t overwhelmed by the needs of COVID-19 patients, that they had enough critical care beds and employees, that there were adequate blood supplies, and to reduce the 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 postponed a 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 also shows that among those who contract COVID-19, people with heart disease and other underlying health conditions tend to get sicker, suffer more serious complications and have fatal outcomes more often than patients who are healthy before getting COVID-19. In addition, physicians discovered more recently that this particular coronavirus can attack the heart and other organs, not just the lungs as first suspected.

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

“We understand that people have concerns about coming to the hospital right now,”Dr. Quesada said. “And some, particularly our international patients, simply can'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 not enough.” For video and audio visits, physicians use the virtual platform Baptist Health Care On Demand, as well as Skype, Zoom, Facetime and other mechanisms.

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

The Institute 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 invasive procedures typically require shorter hospitalizations and an easier recovery than open procedures.

That was the case with the 93-year-old man from Palm Beach, who required a complex combination of techniques. Immediately before the heart valve replacement (actually a valve-in-valve procedure to fix a valve placed years earlier), the patient underwent BASILICA. It’s a new procedure to lacerate the original valve leaflet so that it won’t later obstruct the blood flow in the coronary artery, a complication that can be deadly. The separation allows the new valve to open properly when it is placed.

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