Trans-catheter aortic valve implantation (TAVI). The keys to best practice outcomes. Murray Hart

Optimal outcomes post-TAVI are based on selecting the best or most appropriate patients for the procedure. There has been growing awareness of the importance of frailty as a determinant of patient outcomes. In many TAVI programmes frailty and cognitive assessment are done routinely using standardised scales. The presence of frailty at an advanced age means that aortic valve intervention is less likely to improve quality of life or mortality. Serum albumin is an important marker of frailty.
As part of pre-procedure patient/whanau education setting expectations is key to promoting and expecting the best outcomes. An example of this is the expectation of discharge the day following procedure.
Patient outcomes have improved through a combination of TAVI cardiologists gaining experience, improved valve design, and the procedure becoming more minimally invasive. The less is best approach has decreased complications and morbidity. With a minimally invasive pathway the procedure is performed under conscious sedation, no central venous line, no urinary catheter, CCU length of stay is 3-4 hours, and most patients discharge the day following TAVI procedure.
The mitral valve has complex anatomy but the technology exists to replace it by a transcatheter or percutaneous approach. This technology is not yet available in NZ, but it represents the next step into the future. With new innovation in practice the best is always ahead.
At a personal level, seek to be the best nurse you can. Bullying or workplace violence is common in nursing. Bullies frequently pick on the best, they seduce others to protect themselves, and they blame the target. If you are being bullied at work it is because you are the best. Remember it is not your fault and you are not incompetent. As nurses progress through their career, they will find their passion. Find your passion and follow it.

 

Murray is a Clinical Nurse Specialist in cardiology at Christchurch Hospital. This role encompasses a coronary care unit, cardiology ward, and the Cardiac Cath Lab. In additional to his CNS role, Murray is the Coordinator for the Transcatheter Aortic Valve Implantation (TAVI) programme at Christchurch Hospital.  His background experience within cardiology includes Cardiac Cath Lab, nurse educator, and cardiology research. He is passionate about teaching nurses and growing their professional development.

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