UBC Theses and Dissertations
Transcatheter aortic valve implantation : insights from patients’ peri-procedure experiences Percy, Celeste Grace
Aortic stenosis is the most common valvular heart disease in the elderly population. When left untreated, 50% of patients die within two-years after the onset of symptoms. Transcatheter aortic valve implantation (TAVI) is an evolving new procedure that allows the heart valve to be replaced percutaneously without open-heart surgery. The recent transition to a minimalist procedure and the avoidance of general anaesthesia has further contributed to improving clinical outcomes; however, there is a gap in evidence on patients’ perspectives of these recent changes to their peri-procedure care. The purpose of this study was to explore patients’ experiences of undergoing contemporary TAVI to help inform nursing and multidisciplinary practice. We used a prospective qualitative research design and interpretive description to generate knowledge and insights applicable to clinical practice. We recruited 15 participants (women = 5; mean age = 83 ± 5.4) using purposeful sampling. Each participant was interviewed by telephone within one-week from discharge home from the hospital. We identified an overarching theme of participants’ shared desire to be a member on their Heart Team during their procedure. Participants sought to understand their role in relation to others, how to manage their complex wave of emotions, and how to make sense of the unfamiliar environment. The findings highlighted that there can be a disconnect between the intent to provide patient-centred care during the short but intense TAVI procedure time, and patients’ perceptions of the care they received and their interactions with the team. Patients’ perspectives of being a member of their peri-procedure Heart Team may be facilitated by focused strategies: raising the team’s awareness of the needs of conscious TAVI patients, leveraging perioperative nursing expertise, strengthening the close communication between nursing, anaesthesiology and cardiology around patient assessment and coaching, and modifying patient education resources to match individual patient learning styles and help manage patient expectations. This study offers unique insights to inform future research to develop interventions to improve patients’ experiences during TAVI and contribute to closing the gap between advances in the care of valvular heart disease and the needs of patients.
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