The Nursing Role in Transcatheter Aortic Valve Implantation (TAVI)

Background

Aortic stenosis (AS) is the most prevalent native valve disease in the elderly with a prevalence of 4.6% in adults 75 years of age. Patients with symptomatic severe AS have high risks of sudden death and their 2-year survival rate is only 30-40%. Surgical AVR is the standard of care but Transcatheter Aortic Valve Implantation (TAVI) is an innovative and alternative treatment option for the elderlies. A multi-disciplinary heart team approach has been recommended as Class I indication for managing patients with severe AS according to AHA and ESC guidelines. The “Heart Team” is used to describe the entire multidisciplinary team involved in the care of these high-risk, elderly patients in pre-procedural planning, intra-operative procedural details and post-procedural care It includes cardiologists, cardiac surgeons, radiologists, cardiac anesthesiologists and cardiac nurses.

Being a member of the Heart Team, nurses play a crucial role in the whole patient’s journey. The nurse’s competencies and expertise can provide administrative and clinical leadership within the Heart Team. Cardiac nurses help to screen and evaluate potential candidates, ensure they receive necessary assessment by echocardiogram, CT scan and angiogram to decide on suitability. Besides, the patients and family have to be well-informed for such high risk procedure pre-operatively. Intra-operatively, nurses have to prepare the valve going to be implanted and as an assistant as well after receiving appropriate training. After the procedure, cardiac nurses have to monitor the patient’s recovery and prepare the patient and family for discharge. After discharge, nurses have to keep track on patients’ follow up schedule and ensure ongoing monitoring of the health condition for each patient. Other than clinical duties, cardiac nurses have to organize heart team meetings and keep everyone abreast of the cases. Last but not least, keeping a good data registry with regular audit is very important as well.

Conclusions

In the early era of TAVI, most attention has been drawn to how successful the procedure was done by the physicians. In fact, multi-disciplinary team approach is the key to success. Cardiac nurse as the core member of the Heart Team, not only help to organize and facilitate communication among different disciplines but also integrate best practices for best patient outcomes. Hopefully, this group of high-risk patients can regain their lives with reasonable quality and good outcomes.