Transcatheter Aortic Valve Implantation (TAVI)

Shanthi R

Nursing Incharge, Kauvery Hospital, Tirunelveli, India

Abstract

TAVI stands for Transcatheter Aortic Valve Implantation. It’s a procedure that helps to improve a damaged aortic valve. TAVI is a common, mostly painless procedure. A narrow flexible tube (called a catheter) is put into a blood vessel in the upper leg or chest and is passed towards the aortic valve in the heart. The tube is used to fix a replacement valve over the top of the old one.

Background

A 77y /female patient, with h/o Hypertension but no diabetes, came for TAVI procedure.

H/o PTCA with stenting done to Distal LM to proximal LAD and proximal RCA on 02.08.23.

H/o Nephrectomy done on 2008.

H/o Hysterectomy done on 2018

Examination

CVS: S1, S2 (+)
RS: Bilateral air entry is present
P|A: soft
CNS: NFND
Temp: 98.6 F
SAo2: 90%
BP: 140/90mmHg
HR: 62 beats\min
RR: 14breath\min

Pre-Op Investigations:

Blood Test

HB: 11.5g/dl
WBC Count: 6020 cell/cumm
Platelet count: 234000cell/cumm
PCV: 37.4%
Test (PT): 14 sec
Control: 30 sec
INR: 1.09
Urea: 27.7 mg /dL
Creatinine: 0.89 mg /dL
Potassium: 4.47 mEq/L
Sodium: 138.2mEq/L
RBC: 153mg/dL
Bleeding time: 3 min 45 sec
Clotting time: 5 min 00 sec

Echo

Bicuspid Aortic Valve Thickened, Calcified. AS (severe), AR (Moderate), Normal LV Systolic Function, Stage I Diastolic Dysfunction. LA dilated.

Blood test

HB: 8.1g/dl
Urea: 33.7 mg /dL
Creatinine: 0.95 mg /dL
Potassium: 4.43 mEq/L
Sodium: 135.7mEq/L
RBC: 129mg/dL

Procedure

RFA-6F Pigtail, RFV -TPI, LFA – Fluroguided (proglide XL)

6F-14F cover duplicate of superstiff wire. ALI Thermo Straight tip wire to cross AV- Exchange length J wire exchanged Pigtil -Hemodynamic access (AVG-60mmHg )

Predialated with 16/40 Z- med II balloon under rapid pacing 180 bpm in TPI.

23 mm Evolut R Implanted under fluro guidance in cusps overlap explainer view. LFV Access closed with Proglide XL, and angio seal 8f *1. TPI secured – RFV /RFA stenting secured.

Course in the hospital

Patient was planned for Trans catheter Aortic Valve Implantation on 31.08.23 under general anaesthesia. Post procedural vitals stable. Antiplatelets, Antithyroid, H2 receptor blocker, antibiotics antiemetics, diuretics, B-blocker, statin given. CBC was daily HB -8.1g Hematinic injection was started. Temporary pace maker removed on 02.09.23. Investigation taken Hemoglobin level improved. Patient general condition improved.

Post Procedure investigation:

Echo

Aortic Prosthetic valve in situ Functioning normally. Normal LV Systolic Function stage I Diastolic Dysfunction.

Treatment

Inj. Cefriaxone-750 mg TDS
Inj. Rantac-50mg -TDS
Inj. Emeset -4mg – BD
Inj. Dytor-10mg -OD
Tab. Revolol XL -25mg-OD
Tab. Clavix As -75mg -BD
Tab. Rozat -20 mg -HS
Tab. Glycifer NR -TDS
Tab. Thyroxine 25mcg-OD

Nebulization

Neb: Budecort -1Res-TDS

Neb: Duoline -1Res-TDS

Diet advice

During post-operative periods, initiate the liquid diet. After that, semi solid, solid diet and normal diet was given to the patient. Patient was tolerated well.

Eat heart-healthy foods

Nursing management

Walking is a good exercise for the lungs and heart. Advised to take it slowly at first.
Do not do any activity or exercise that causes pulling or pain across your chest, (such as using a rowing machine, twisting, or lifting)
The patient and family were provided with information that will enable them to co-operate with the care and restrictions required to preparation them to return home.
Educated the patient and family Wash your hands with soap and water
Taught the use of assistive devices or modification of the home environment to help improve the health.

Follow up appointment

The patient and family are reminded of the Importance of Following recommendation and keeping with follow up appointments with health care providers for monitoring of risk factors.

Outcome

Patient was hemodynamically stable. On Discharge.

Transcatheter Aortic Valve Implantation (TAVI)