Trans catheter Aortic Valve Implantation (TAVI)

Soundarya. A

MICU – Staff Nurse, Kauvery Hospital, Vadapalani, Chennai

Abstract

Severe symptomatic aortic stenosis carries a very poor prognosis. TAVI is a minimally invasive procedure- a new aortic valve is inserted without removing the old, damaged valve. The new valve is placed inside the diseased valve. It’s a procedure linked to a lower risk of infection, shorter hospital stay and a reduced recovery time than traditional open surgery. TAVR has been demonstrated to change the natural history of the disease.

Case Presentation

A 76 years old female patients was admitted with the following complaints,

Chest pain.
Rapid, fluttering heartbeat.
Trouble breathing or feeling short of breath.
Feeling dizzy or light-headed, even fainting.
Difficulty walking short distances.
Swollen ankles or feet.
Difficulty sleeping or needing to sleep sitting up.

She was diagnosed to have Severe Aortic Valve Stenosis and advised TAVI. The procedure was has was explained to her and she was admitted for the elective Interventional procedure.

On the day of admission blood investigations were done such as CBC/RFT/LFT/ were done, Viral markers were non-reactive. ECG showed Atrial Flutter. ECHO showed moderate LV Function. Vital signs were

She was known to have Systemic Hypertension.

Temperature	98 .4°F
Pulse	96 beats/minute
Blood Pressure	130/80 mmHg
RR	18 breaths/min
SpO2	98% in Room Air

Over View of TAVI procedure

Sheunderwent the TAVI Procedure and received in Coronary Intensive Care Unit for post procedural observation.

TAVI Protocol

We followed the protocol for the Post OP TAVI Patients.

Vital Monitoring

She was on continuous cardiac monitor, which showed the ECG rhythm and other vital parameters such as temperature, pulse, blood pressure and Oxygen Saturation. Rhythm was monitored continuously.

Neuro Assessment

As per the protocol, the head was elevated 30 degrees. We checked her level of consciousness by using GCS Scale for the first 12 hours, thereafter assessed her every 2^nd hourly for the next 12 hr.

Vascular Assessment

For the first one hour, every 15 min. We assessed her incision site for any redness, swelling, bleeding or hematoma, then assessed the site every 30 min for the next 5 hr. Further, for the next 24 hr. Hourly assessment was done.

Arterial blood gases

ABG was done to measure the acid base balance in the blood. Her values as follows

pH	7.41	As per the protocol, the ABG was repeated after 6 hr if the lactate level increased.
The repeated ABG showed that the values were within normal limits.
pCO2	42
pO2	77
Na	135
K	3.7
HCO3	26.6
Lac	2.0

Blood Investigations

Post procedure Complete Blood Count (CBC) was checked if it was lower than normal, transfusion was not required as her Hb was within normal range.

Electrocardiogram

ECG was done immediately after the procedure and showed normal sinus rhythm.

Intravenous therapy

She was started on IV antibiotics Inj. Magnex Forte 1.5g twice a day and Inj. Teicoplanin 400mg IV stat.

Position

Maintained the propped up position and the lower limb movement on the side of the access site was restricted for 24 hrs.

Bladder and Bowel status was good.

Diet

Soft solids, with salt restricted.

Post procedure, she was regularly reviewed at the ICU by the cardiologist and the ICU Intensivist, She was transferred to the ward and her clinical condition was good.

Management

She was mobilized with the support. For some after her mobilization she had giddiness and palpitations.

MEWS – 3. ECG showed and LBBB rhythm with AF.

Immediately she was seen by the ICU Doctor and cardiologist and was shifted to ICU. Connected to the Monitor which showed atrial fibrillation with Forearm Vascular resistance

Administered IV Ibutilide 1 mg slow IV followed by Inj. Cardarone 150mg IV and Inj. Heparin 5000IU IV Stat followed by she was started on Inj. Cardarone continuous Infusion at the 60mg/hr.

Later her ECG showed intermittent AF and it became normal by the evening. Other vital parameters remained normal.

Considering that her blood values and the clinical condition were stable, the patient was shifted ward , on the oral antiarrhythmic drugs. She later had mild oozing at the incision site; femoral Doppler was done to rule out hematoma. The cardiologist advised to withhold the heparin.

Her vital parameters remained stable, mobilized and later discharged.

Soundarya. A
MICU – Staff Nurse

Trans catheter Aortic Valve Implantation (TAVI)

Trans catheter Aortic Valve Implantation (TAVI)

Soundarya. A

Nightingale Journals