BACKGROUND: The response to COVID-19 has required cancellation of all but the most urgent procedures; there is therefore a need for the reintroduction of a safe elective pathway .
METHODS: This was a study of a pilot pathway performed at Barts Heart Centre for the admission of patients requiring elective coronary and structural procedures during the COVID-19 pandemic (April-June 2020). All patients on coronary and structural waiting lists were screened for procedural indications, urgency and adverse features for COVID-19 prognosis and discussed at dedicated multidisciplinary teams . Dedicated admission pathways involving preadmission isolation, additional consent, COVID-19 PCR testing and dedicated clean areas were used .
RESULTS : 143 patients (101 coronary and 42 structural) underwent procedures (coronary angiography, percutaneous coronary intervention, transcatheter aortic valve intervention and MitralClip) during the study period . The average age was 68.2; 74% were male; and over 93% had one or more moderate COVID-19 risk factors . All patients were COVID-19 PCR negative on admission with (8.1 %) COVID-19 antibody positive (swab negative). All procedures were performed successfully with low rates of procedural complications (9.8 %). At 2-week follow-up, no patients had symptoms or confirmed COVID-19 infection with significant improvements in quality if life and symptoms .
CONCLUSION: We demonstrated that patients undergoing coronary and structural procedures can be safely admitted during the COVID-19 pandemic, with no patients contracting COVID-19 during their admission . Reassuringly, patients reflective of typical practice, that is, those at moderate or higher risk, were treated successfully . This pilot provides important information applicable to other settings, specialties and areas to reintroduce services safely.