1 Department of Health Science and Technology, The Faculty of Medicine, Aalborg University, VBN2 The Faculty of Medicine, Aalborg University, VBN3 Centre for Clinical Guidelines, The Faculty of Medicine, Aalborg University, VBN4 unknown
an observational study
Background:Conventional treatment for patients with severe symptomatic aortic stenosis is surgical aortic valve replacement (SAVR), but transcatheter aortic valve implantation (TAVI) has become a reliable alternative in high-risk patients.Aims:The aim of our study was to describe the post-operative patient response to TAVI on the evening of the procedure and the following day before discharge from the coronary care unit. A secondary aim was to compare responses of patients younger and older than 80 years of age.Methods:A prospective, comparative observational study triangulating nurse assessment and structured interviews on a cohort of 54 Danish patients: 28/26 male/female, 26/28 younger/older than 80. Mean age in the younger/older group was 73/85 years.Results:After TAVI pain was experienced by 47 (87%) patients; 29 (62%) were restricted by pain, and 24 (44%) had discomfort at the femoral insertion site. Disturbed sleep/rest were reported by 34 (63%)/29 (55%) patients; nausea/vomiting by 14 (26%)/5 (9%) patients, restricting eating/drinking in 11 (21%)/8 (15%) patients. Sinus rhythm/atrial fibrillation/paced rhythm were observed in 35 (65%)/8 (15%)/21 (39%) patients; bleeding/haematoma/oozing from femoral insertion site in 23 (45%)/10 (19%)/23 (43%) patients.Conclusion:Patients older than 80 years did as well as the younger patients in our study; the main complaints were post-operative pain and disrupted sleep. Our numbers are small, but most patients experienced considerable pain, predominantly continuous and at rest. We recommend the development of an evidence-based pathway to address the immediate post-operative issues in TAVI patients. Non-pharmacological interventions to prevent pain and promote sleep need to be explored.
European Journal of Cardiovascular Nursing, 2015, Vol 14, Issue 3, p. 232-239