Management of Structural Heart Disease and Acute Coronary Syndromes in the COVID-19 Pandemic

Abstract

Transcatheter interventions for structural heart disease (SHD) now represent an effective alternative to surgery in selected patients. A clear premise is that delay in or neglect of treating patients in need of SHD intervention is associated with unavoidable morbidity and mortality because many of them have life-threatening conditions. However, the recent outbreak of coronavirus-associated disease-2019 (COVID-19) is placing an unprecedented strain on patients, physicians and world healthcare systems that resulted in deferral of elective and semi-elective procedures, such as SHD, and delay in the treatment of patients with acute coronary syndrome (ACS). We hereby present the case for a focused resumption of transcatheter SHD interventions in selected centers, in order to preserve patient safety and avoid that death rate will extend far beyond that directly associated with COVID-19. A similar approach should be applied to the invasive management of ACS. Indeed, a proactive and vigilant stance on managing SHD and ACS is crucial, especially in the context of the COVID-19 pandemic, when the risk of overlooking severely sick patients or postponing life-saving treatments is high. If such corrective measures are not put into effect, we may expect in the near future an excess of avoidable fatalities indirectly due to COVID-19 but truly caused by cardiovascular diseases, as well as an exceedingly large number of patients with severe heart failure leading to shorter life expectancy, reduced quality of life and increased healthcare cost.