‘I want to be a member of my heart team’: Insights from patients’ experiences of minimalist transcatheter aortic valve implantation

Celeste Percy; Fuchsia Howard; Bobby Lee; Janarthanan Sathananthan; David Wood; John Webb; Sandra Lauck

doi:10.26550/2209-1092.1285

Authors

Celeste Percy University of British Columbia
Dr Fuchsia Howard University of British Columbia
Dr Bobby Lee University of British Columbia
Janarthanan Sathananthan University of British Columbia
Dr David A Wood University of British Columbia
Dr John G Webb University of British Columbia
Dr Sandra B Lauck University of British Columbia

DOI:

https://doi.org/10.26550/2209-1092.1285

Keywords:

transcatheter aortic valve replacement, peri-procedure nursing, minimalist approach, anaesthesia, patient experience, qualitative

Abstract

Background: Internationally, transcatheter aortic valve implantation (TAVI) is the most common approach for treating aortic stenosis. There is growing evidence to support the implementation of a streamlined clinical pathway to optimise outcomes, improve capacity and facilitate safe early discharge home. Best practices that are emerging include adopting a minimalist approach and transition from general anaesthesia to conscious sedation or local anesthesia only. We aimed to explore what could be learned from patients’ experiences
of their care in this rapidly evolving context.

Methods: We conducted a qualitative study of patients in the first week after TAVI to explore their perspectives of the procedure and elicit their recommendations. We used interpretive description as the methodological approach to not only inform data collection and analysis but also to generate evidence to inform practice.

Results: We recruited 15 participants, five women and ten men, with a mean age of 83 years (±5.4) who had transfemoral TAVI with minimal sedation (n=14) in a hybrid operating room (n=6) or a cardiac catheter laboratory (n=9) and were discharged home without complications the day after their procedure. The overarching theme of ‘I want to be a member of my heart team during my procedure’ emerged, and was illustrated by three themes: ‘Who am I to
them?’ (situating self in relation to the team), ‘How can I be a good patient?’ (knowing expectations of me) and ‘How do I manage this complex wave of emotions?’ (interpreting team signals). Participants provided unique recommendations, including patient participation during safety checkpoints, communication protocols, education and raised awareness of patients’ needs during minimalist TAVI.

Conclusions: The rapid emergence of minimalist approaches for the treatment of valvular heart disease warrants tailored strategies to integrate patients’ needs. Further research is needed to ensure the adoption of patient-centred practices during TAVI.