Immediate post-operative responses to transcatheter aortic valve implantation: An observational study.

Autor: Egerod I; Trauma Centre, Copenhagen University Hospital Rigshospitalet, Denmark ingrid.egerod@regionh.dk., Nielsen S; Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark., Lisby KH; Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark., Darmer MR; Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark., Pedersen PU; Centre of Clinical Guidelines, Aalborg University, Denmark.
Jazyk: angličtina
Zdroj: European journal of cardiovascular nursing [Eur J Cardiovasc Nurs] 2015 Jun; Vol. 14 (3), pp. 232-9. Date of Electronic Publication: 2014 Feb 18.
DOI: 10.1177/1474515114525521
Abstrakt: Background: Conventional treatment for patients with severe symptomatic aortic stenosis is surgical aortic valve replacement (SAVR), but transcatheter aortic valve implantation (TAVI) has become a reliable alternative in high-risk patients.
Aims: The aim of our study was to describe the post-operative patient response to TAVI on the evening of the procedure and the following day before discharge from the coronary care unit. A secondary aim was to compare responses of patients younger and older than 80 years of age.
Methods: A prospective, comparative observational study triangulating nurse assessment and structured interviews on a cohort of 54 Danish patients: 28/26 male/female, 26/28 younger/older than 80. Mean age in the younger/older group was 73/85 years.
Results: After TAVI pain was experienced by 47 (87%) patients; 29 (62%) were restricted by pain, and 24 (44%) had discomfort at the femoral insertion site. Disturbed sleep/rest were reported by 34 (63%)/29 (55%) patients; nausea/vomiting by 14 (26%)/5 (9%) patients, restricting eating/drinking in 11 (21%)/8 (15%) patients. Sinus rhythm/atrial fibrillation/paced rhythm were observed in 35 (65%)/8 (15%)/21 (39%) patients; bleeding/haematoma/oozing from femoral insertion site in 23 (45%)/10 (19%)/23 (43%) patients.
Conclusion: Patients older than 80 years did as well as the younger patients in our study; the main complaints were post-operative pain and disrupted sleep. Our numbers are small, but most patients experienced considerable pain, predominantly continuous and at rest. We recommend the development of an evidence-based pathway to address the immediate post-operative issues in TAVI patients. Non-pharmacological interventions to prevent pain and promote sleep need to be explored.
(© The European Society of Cardiology 2014.)
Databáze: MEDLINE