Peri-procedure experiences during minimalist transcatheter aortic valve implantation: insights from patients' perspectives

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background There is growing evidence to support the implementation of a streamlined clinical pathway to optimise outcomes, improve program capacity, and facilitate safe early discharge home after transcatheter aortic valve implantation (TAVI). In the peri-procedure phase, the adoption of a minimalist approach has accelerated the rapid transition from the use of general anaesthesia to default strategies ranging from conscious sedation to local anaesthesia only. Little is known of patients’ perspectives with undergoing minimalist TAVI. We aimed to explore what could be learned from this episode of care to inform multidisciplinary practice. Methods We conducted a prospective single centre qualitative study of TAVI patients within the first week of their discharge home, using purposeful sample to recruit a diverse population. We conducted individual interviews, using a semi-structured interview guide informed by pilot work and current evidence; open-ended questions were designed to explore patients’ perspectives of their peri-procedural experiences, inclusive of their recall of the procedure, interactions with team members, and the overall care received. Data were analyzed using interpretive description, a methodological approach appropriate to inform the knowledge needs of applied disciplines and conducive to generating new ideas and augment existing knowledge in the context of clinical practice. Results We recruited 15 participants, including 5 women, median age 82 (IQR 77,86); all patients had severe symptomatic aortic stenosis and multiple co-morbidities. TAVI was conducted using a transfemoral approach, with local anaesthesia only (n=4) or minimal sedation (n=11). Median length of stay was 1 day; one participant required a new permanent pacemaker; all participants were discharged home. The overarching theme of "I want to be a member of my Heart Team during my procedure" emerged; this aspiration, request and/or need was illustrated by three main themes: (1) "Who am I to them?", (2) "How can I be a good patient?", and (3) "How do I manage this complex wave of emotions?". Conclusions The rapid emergence of minimally invasive options for the treatment of valvular heart disease has established a new standard of care. Peri-procedure care initially informed by surgical practices have now shifted to most patients being conscious during TAVI and cared for by a smaller clinical team. The awareness of patients’ perspectives, and their inclusion in the Heart Team’s dynamics and processes offer important insights to optimise patients’ experiences of procedural care and clinical outcomes.