A Cath lab nurse’s first experience with Transcatheter Aortic Value Implantation (TAVI)
Riyaz H1*, Gowdham Pannirselvam2
1Nursing Officer, Cath Lab, Kauvery Hospital, Marathahalli, Bangalore
2Senior Nurse Educator, Kauvery Hospital, Marathahalli, Bangalore
*Correspondence
Abstract
Transcatheter Aortic Valve Implantation (TAVI) has emerged as an effective and less invasive alternative to Surgical Aortic Valve Replacement (SAVR) for patients with severe symptomatic aortic stenosis, particularly among elderly individuals and those with increased surgical risk. This case report describes the clinical management of an 83-year-old male patient diagnosed with severe degenerative aortic stenosis who successfully underwent TAVI using a 26 mm Medtronic Evolut FX valve via the right femoral approach. The report is uniquely presented from the perspective of a Cath Lab Nurse experiencing his first TAVI procedure. It highlights patient assessment, procedural preparation, intraoperative nursing responsibilities, post-procedure care, and multidisciplinary collaboration. The case emphasizes the critical role of Cath Lab nurses in ensuring procedural safety, maintaining sterile techniques, monitoring hemodynamic stability, and facilitating patient recovery. The successful outcome demonstrates the importance of specialized nursing knowledge and teamwork in advanced structural heart interventions.
Keywords: Transcatheter Aortic Valve Implantation TAVI; Aortic Stenosis; Cath Lab Nursing; Structural Heart Disease; Nursing Care.
Introduction
Aortic stenosis is the most common valvular heart disease among elderly individuals and is associated with significant morbidity and mortality when left untreated. Degenerative calcification of the aortic valve progressively narrows the valvular opening, resulting in obstruction of left ventricular outflow and eventual heart failure, syncope, and sudden cardiac death if untreated [1].
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Traditionally, Surgical Aortic Valve Replacement (SAVR) has been considered the gold standard treatment for severe symptomatic aortic stenosis. However, many elderly patients have multiple comorbidities that increase surgical risk. Transcatheter Aortic Valve Implantation (TAVI), first introduced by Cribier in 2002, has revolutionized the treatment of severe aortic stenosis by providing a minimally invasive alternative with favourable outcomes [2].
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The role of nursing professionals in TAVI procedures has expanded significantly. Cath Lab nurses are involved in patient assessment, pre-procedure preparation, intra-procedure monitoring, equipment management, post-procedure surveillance, and patient education. This case report presents the experience of participating in a first TAVI procedure as a Cath Lab Nurse and highlights the nursing implications associated with this advanced cardiac intervention.
Case Presentation
An 83-year-old male patient presented with complaints of progressive exertional dyspnoea and easy fatigability. His symptoms had gradually worsened over several months, limiting his daily activities and reducing functional capacity. The patient was a known case of hypertension, Type 2 Diabetes Mellitus, and dyslipidaemia. He also had a recent history of renal dysfunction that had recovered prior to admission. There was no history of drug allergies.
On admission, clinical examination revealed a hemodynamically stable elderly male. His pulse rate was 72 beats per minute, blood pressure was 142/70 mmHg, respiratory rate was 22 breaths per minute, oxygen saturation was 99% on room air, and body temperature was 98.6°F. Cardiovascular examination revealed findings suggestive of severe aortic stenosis. Respiratory examination demonstrated bilaterally equal breath sounds, while neurological examination showed the patient to be conscious, alert, and oriented.
Further investigations were performed to evaluate the severity of the valvular disease. Electrocardiography demonstrated sinus rhythm with evidence of left ventricular hypertrophy. Two-dimensional echocardiography revealed severe degenerative aortic valve disease with severe aortic stenosis. The peak pressure gradient was 80 mmHg and the mean pressure gradient was 55 mmHg. Mild aortic regurgitation, concentric left ventricular hypertrophy, dilated left atrium, grade II left ventricular diastolic dysfunction, mild mitral regurgitation, and mild tricuspid regurgitation were also identified. Left ventricular ejection fraction was preserved at approximately 55–56%. Following multidisciplinary heart team evaluation, the patient was diagnosed with severe symptomatic degenerative aortic stenosis. Considering the patient’s advanced age and overall clinical condition, the heart team recommended Transcatheter Aortic Valve Implantation as the preferred treatment option. The patient and family members were counselled regarding the disease process, procedural options, benefits, risks, and expected outcomes. After obtaining informed consent, the patient was scheduled for elective TAVI.
Cath Lab Nurse Experience During the First TAVI Procedure
This procedure represented my first experience assisting in a Transcatheter Aortic Valve Implantation as a Cath Lab Nurse. Prior to the procedure, extensive preparation was undertaken to ensure familiarity with the workflow, equipment, emergency protocols, and nursing responsibilities. The Cath Lab was prepared according to institutional protocols. Equipment checks included verification of the TAVI delivery system, transcatheter valve, vascular access kits, temporary pacing equipment, hemodynamic monitoring systems, emergency resuscitation equipment, and imaging support devices. Sterility of all instruments and implants was carefully confirmed.
The patient was transported to the Cath Lab after appropriate pre-procedure preparation. Baseline vital signs were recorded, and intravenous access was secured. Continuous electrocardiographic monitoring, pulse oximetry, and invasive blood pressure monitoring were initiated. As part of the nursing role, I participated in patient identification verification, procedural timeout, medication preparation, anticoagulation administration support, and maintenance of a sterile field throughout the procedure. Close coordination was maintained with the interventional cardiologist, anaesthesiology team, radiology technologists, and fellow nursing staff. The procedure was performed via the right femoral arterial approach. Under fluoroscopic guidance, vascular access was obtained and the diseased native aortic valve was crossed. A 26 mm Medtronic Evolut FX transcatheter valve was advanced through the delivery system and positioned accurately within the native valve annulus.
During valve deployment, continuous monitoring of hemodynamic parameters was essential. Attention was given to cardiac rhythm disturbances, blood pressure fluctuations, oxygen saturation, and patient stability. Emergency pacing equipment remained readily available throughout the procedure. The valve was successfully deployed without major complications. Immediate post-deployment assessment demonstrated excellent valve positioning and satisfactory hemodynamic results. For a Cath Lab Nurse, witnessing the restoration of valve function and observing the patient’s stabilization following deployment was both educational and professionally rewarding. The procedure reinforced the importance of teamwork, communication, and meticulous attention to detail in advanced structural heart interventions.
Clinical Outcome
Following successful TAVI, the patient was transferred to the Intensive Care Unit for close observation. During the immediate post-procedure period, the patient required Nitroglycerin infusion to manage elevated blood pressure. The patient remained hemodynamically stable throughout the recovery period. Follow-up echocardiography demonstrated a normally functioning aortic prosthetic valve with a peak gradient of 9 mmHg and mean gradient of 6 mmHg. Only trivial paravalvular leak was noted. Left ventricular function remained preserved with an ejection fraction of 56%. The patient showed significant symptomatic improvement and was mobilized successfully. Following stabilization, he was transferred from the ICU to the ward. After multidisciplinary review and completion of post-procedure assessments, the patient was discharged in stable condition with instructions for medication adherence, blood pressure monitoring, diabetes management, dietary modification, and outpatient follow-up.
Discussion
Severe aortic stenosis is associated with poor prognosis once symptoms develop. Without intervention, mortality rates increase substantially within two to three years after symptom onset [3]. The prevalence of aortic stenosis rises significantly with advancing age, making it a common cardiovascular condition among elderly populations [4]. TAVI has transformed the management of severe aortic stenosis by providing a less invasive therapeutic option. Multiple landmark clinical trials have demonstrated comparable or superior outcomes compared with surgical valve replacement in selected patient populations [5,6].
The present case illustrates the successful use of TAVI in an elderly patient with symptomatic severe degenerative aortic stenosis. The procedure resulted in substantial reduction of transvalvular gradients and clinical improvement, findings consistent with previously published studies [7]..One of the major advantages of TAVI is avoidance of sternotomy and cardiopulmonary bypass, leading to reduced procedural trauma and shorter recovery times [8]..Elderly patients often benefit significantly from this minimally invasive approach due to reduced surgical stress and faster rehabilitation. Current evidence suggests that TAVI provides excellent hemodynamic performance with durable outcomes. The Medtronic Evolut FX valve utilized in this case is a self-expanding supra-annular bio prosthesis designed to optimize valve positioning and minimize complications [9].
From a nursing perspective, TAVI procedures require extensive preparation and specialized competencies. Nurses play a vital role throughout the continuum of care. Pre-procedure responsibilities include patient education, psychosocial support, baseline assessment, and procedural preparation. During the intervention, nurses are responsible for maintaining sterility, assisting with device preparation, monitoring patient status, and responding rapidly to complications [10]. Potential complications associated with TAVI include vascular injury, bleeding, stroke, arrhythmias, conduction disturbances, valve malposition, and paravalvular leak [11]. Early recognition of these complications relies heavily on vigilant nursing observation and hemodynamic monitoring.
Post-procedural nursing care is equally important. Monitoring vascular access sites, evaluating neurological status, assessing cardiac rhythm, and ensuring early mobilization contribute significantly to favourable patient outcomes [12]. The experience of participating in a first TAVI procedure provided valuable insights into advanced structural heart interventions. The complexity of the procedure highlighted the necessity of continuous professional education, interdisciplinary communication, and evidence-based nursing practice. As TAVI indications continue to expand worldwide, Cath Lab nurses must acquire specialized knowledge regarding valve technologies, procedural workflows, complication management, and patient-centered care strategies [13]. Structured training programs have been shown to improve procedural efficiency and patient safety in structural heart interventions [14].
This case also emphasizes the importance of the heart team approach. Collaboration among cardiologists, anesthesiologists, nurses, imaging specialists, and other healthcare professionals remains a cornerstone of successful TAVI programs [15]. The favorable outcome observed in this patient reflects not only technological advancements but also the contribution of coordinated multidisciplinary care. Nursing involvement remains fundamental to ensuring procedural success and optimizing patient recovery [16].
Nursing Management and Nursing Implications
The nursing management of patients undergoing TAVI begins with comprehensive pre-procedural assessment, including evaluation of vital signs, laboratory parameters, medication history, and psychosocial readiness. Patient and family education regarding procedural expectations, risks, benefits, and recovery plays an essential role in reducing anxiety and promoting informed decision-making.
During the procedure, Cath Lab nurses are responsible for preparing sterile equipment, maintaining aseptic technique, monitoring hemodynamic status, documenting procedural events, and facilitating communication among team members. Immediate recognition of changes in blood pressure, heart rhythm, oxygenation, or neurological status is crucial.
Post-procedure nursing care focuses on continuous cardiac monitoring, assessment of vascular access sites, pain management, prevention of complications, early mobilization, and discharge education. Nurses also reinforce medication adherence, dietary modifications, glycaemic control, and follow-up requirements. This case highlights the need for specialized training and competency development among Cath Lab nurses involved in structural heart procedures. Ongoing education and simulation-based learning can enhance confidence, procedural proficiency, and patient safety outcomes.
Conclusion
Transcatheter Aortic Valve Implantation represents a major advancement in the treatment of severe symptomatic aortic stenosis, particularly among elderly patients with elevated surgical risk. This case demonstrates successful management of severe degenerative aortic stenosis using a 26 mm Medtronic Evolut FX valve with excellent clinical outcomes. From a Cath Lab Nurse’s perspective, participation in a first TAVI procedure was a significant professional learning experience that emphasized the importance of preparation, vigilance, teamwork, and evidence-based nursing practice. As TAVI continues to evolve, nursing professionals will remain integral to ensuring safe procedural performance and optimal patient outcomes.
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