ArticleContemporary nursing care in transcatheter aortic valve replacement
Section snippets
Pathology
There are three main causes linked to AS: 1) calcific disease, 2) congenital bicuspid valve, and 3) rheumatic heart disease. Calcific disease and a bicuspid valve are most common in industrialized nations, with bicuspid valves accounting for 2% of cases.1 Other less common causes include homozygous familial hypercholesterolemia, congenital heart disease, radiation to the chest, renal failure, and Paget disease.6, 7 This article focuses on calcific AS apropos to its higher prevalence and
Treatment
According to the current guidelines, TAVR is an indication for inoperable, high-risk, and intermediate-risk surgical patients as an alternative to surgical aortic valve replacement.9 The heart team is responsible for deeming the patients' appropriateness for TAVR. Preoperative assessment includes assessing the predicted risk of mortality score, frailty, organ system dysfunction, and procedure-specific impediments.9 Together, these factors determine a patient's surgical risk and treatment
Postprocedural nursing care
The postprocedural period is where the acute/critical care nurse may have the most impact. Anticipating and monitoring for complications is the main area of focus. Complications of the postprocedural period that we will go over are vascular complications, stroke, acute kidney injury (AKI), and new-onset atrial fibrillation (AF).
Vascular complications are the most common postprocedural complications in TAVR.13 They are associated with increased morbidity, mortality, length of stay, and decreased
Home instructions for patients and families
Upon discharge, patients and family members likely have many questions in regard to home care and activity restrictions. It is pertinent to listen to all questions and concerns and be prepared to answer questions and provide written information to reinforce teaching.
The most common questions regard access sites and activity. Having a femoral access site, the patient should avoid strenuous activity, such as heavy lifting, for approximately 1 week, unless otherwise specified by their doctor.
Conclusion
With the increase in TAVR centers and procedures, nurses must expand their knowledge and scope to care for these patients. Better understanding of the procedure and possible complications leads to more meaningful nursing care and better patient outcomes through rapid detection and intervention.
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Cited by (1)
Transcatheter Aortic Valve Replacement: Clinical Update for Nurse Practitioners
2021, Journal for Nurse PractitionersCitation Excerpt :NPs can use the physical examination to assist in the identification of patients with AS who will need referral for further testing.3 A systolic murmur, which is typically harsh and occurs in a low-pitch, crescendo-decrescendo pattern, is identified as an aortic valve murmur.3,13 The murmur may also radiate up toward the right carotid artery.14
Disclosure: The authors have nothing to disclose.