Adaptation of the Healthcare Team as The Key to TAVI Implantation

Abstract

We present the case of a 79-year-old female patient with a history of ischemic heart disease revascularized with stents and severe aortic stenosis, recently included in the surgical waiting list for treatment. She consulted for syncope and humerus fracture, preceded by chest pain with electrocardiographic changes. During the sequence of diagnostic tests indicated in this context, she suffered a severe clinical worsening, complicating to the point of acute pulmonary edema, cardiogenic shock and requiring mechanical ventilation. The underlying cause was severe aortic stenosis and, therefore, the ideal treatment was urgent percutaneous aortic valve implantation, since he had a peak peak gradient of 64 mmHg. The resolution of the case was not easy, since it required the transfer of a hemodynamically unstable patient from her hospital to the center specialized in TAVI implantation, located only 2 km away. What was new and exceptional was the adaptation of the usual treatment strategy (transfer of the patient to the referral center and scheduled implant) to a patient-centered strategy, which required the transfer of the TAVI expert team (nurses and physicians) together with the implant kit to the hospital where the patient was admitted.