Transcatheter Aortic Valve Implantation Outcomes

Abstract

Aortic stenosis is a common valvular pathological finding in older adults. Currently, aortic valve replacement is the gold-standard treatment for severe symptomatic aortic stenosis. However, patients with advanced age and multiple comorbidities carry a significant operative risk. Transcatheter aortic valve implantation (TAVI) was developed with the goal of offering a less invasive alternative to symptomatic high-risk patients with aortic stenosis. Since the first successful TAVI procedure in 2002, TAVI has been used as a treatment option for patients at very high or prohibitive surgical risk in clinical feasibility trials, registries, and in ongoing randomized controlled trials. There are 2 transcatheter valves in widespread clinical application, with several others in different stages of development. This article provides an overview of TAVI outcomes including insertion options, procedural outcomes, morbidity, valve durability, short- to medium-term survival, and quality of life to guide nursing care interventions. Enhancing nurses' knowledge of the risks, benefits, and potential complications of TAVI will empower nurses in their role as patient advocates and educators and improve patient outcomes. Gaps in the current TAVI research literature are identified.

Transcatheter Aortic Valve Replacement for Severe Aortic Stenosis

“…30 Delirium is associated with poor outcome including increased hospital stay, increased nursing home placement, and greater mortality. 30 Delirium is associated with poor outcome including increased hospital stay, increased nursing home placement, and greater mortality.…”

“…30 Delirium is associated with poor outcome including increased hospital stay, increased nursing home placement, and greater mortality. 30,31 While delirium may be present with agitation or self-harming behaviors, hypoactive delirium can be easily missed. A cognitive baseline assessment with a tool such as the Mini-Mental State Exam and Confusion Assessment Method for the ICU is useful.…”

“…30 Since stroke is a major source of mortality in patients after TAVR and the incidence more often peaks within the first week, nurses should be vigilant about assessing patients after TAVR for signs and symptoms of stroke. A baseline of computed tomography or magnetic resonance imaging of brain can be suggested.…”

“…The use of nonnarcotic agents as first-line pain control with narcotics added as adjuvants can help decrease narcotic-induced delirium. 30,31 Cardiac Patients should be educated before TAVR on device-induced conduction abnormality and the possible need for permanent pacemaker implantation, especially if a patient already has any of the predictors of heart block. 31 In the absence of significant postprocedure bleeding, anticoagulation is usually initiated on postprocedure day 1.…”

“…30 Since stroke is a major source of mortality in patients after TAVR and the incidence more often peaks within the first week, nurses should be vigilant about assessing patients after TAVR for signs and symptoms of stroke. 30 After TAVR, rapid access to transcutaneous pacing should be readily available in case it is needed. 31 Dual antiplatelet therapy (aspirin and clopidogrel) may be used as recommended by the valve manufacturers.…”