Severe valvular disease, COVID-19 mortality ‘approaching’ 50% at 30 days
Thirty-day mortality among patients with severe valvular heart disease and COVID-19 topped more than 40%, according to data presented at the virtual Society for Cardiovascular Angiography and Interventions Scientific Sessions.
Performing an invasive surgical or transcatheter procedure for valvular disease management in appropriate patients, even during the infection, was associated with lower prevalence of 30-day all-cause mortality, a speaker reported.
“Patients with COVID-19 and severe valvular heart disease have poor clinical outcomes with mortality approaching 50% within 30 days of hospital admission,” Danny Dvir, MD, director of interventional cardiology at the Shaare Zedek Medical Centre at Hebrew University in Jerusalem, said during the presentation. “It seemed that valve repair or replacement in appropriate patients should still be considered in those at risk for infection, possibly during the infection. Although the present study suggests that this approach might be lifesaving, further studies are warranted to confirm the results.”
For this multicenter trial, researchers included 136 patients (mean age, 80 years; 52% men) hospitalized with concomitant COVID-19 infection and severe valvular heart disease from an international valve disease registry.
In total, 74 patients had severe aortic stenosis, 28 had severe mitral regurgitation, 14 had severe tricuspid regurgitation, 11 had severe aortic regurgitation and nine had severe mitral stenosis.
The cohort had a high prevalence of hypertension (77%), diabetes (35%), CAD (38%) and chronic kidney disease (36%), as well as a frequent history of dyspnea (83%).
In most patients, COVID-19 was managed using antibiotics (84%), hydroxychloroquine (75%) or antivirals (54%).
About 12% of patients with concomitant COVID-19 and severe valvular disease underwent invasive mechanical ventilation.
Only about half of the population was treated with anticoagulants, with 22.8% receiving low-molecular weight heparin, 14.7% receiving warfarin and 9.6% on direct oral anticoagulants.
At 30 days, the prevalence of all-cause mortality in the cohort was 41.8%, Dvir said.
Among the cohort, 11% underwent transcatheter or surgical valve replacement, and 80% of those who had a replacement procedure had a transcatheter one. In addition, 1.5% had valve repair, 2.9% had balloon valvuloplasty and 84.6% were managed conservatively, Dvir said.
Among patients with aortic stenosis younger than 80 years who underwent valve replacement, the prevalence of 30-day all-cause mortality was 11.1% compared with 23.5% in those who were not invasively treated.
Among patients with aortic stenosis aged at least 80 years who underwent valve replacement, the prevalence of 30-day all-cause mortality was 16.7% compared with 59.5% in those who were not invasively treated.
“Obviously, there is some bias in the analysis, but we can say in general that patients that were treated during the infection for the valve disease did very well,” Dvir said during the presentation.
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Dvir D. COVID-19 in 2021: Interventional perspectives. Presented at: Society for Cardiovascular Angiography and Interventions Scientific Sessions; April 28-May 1, 2021 (virtual meeting).
