title: Immediate post-operative responses to transcatheter aortic valve implantation: An observational study.
abstract: 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.
  
  
  OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Trauma Centre, Copenhagen University Hospital Rigshospitalet, Denmark ingrid.egerod@regionh.dk.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Egerod
authors.affiliation: Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark.
authors.forename: Susanne
authors.initials: S
authors.lastname: Nielsen
authors.affiliation: Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark.
authors.forename: Karen H
authors.initials: KH
authors.lastname: Lisby
authors.affiliation: Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark.
authors.forename: Mette R
authors.initials: MR
authors.lastname: Darmer
authors.affiliation: Centre of Clinical Guidelines, Aalborg University, Denmark.
authors.forename: Preben U
authors.initials: PU
authors.lastname: Pedersen
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000008:administration & dosage; D000928:Antidepressive Agents / Q000008:administration & dosage; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D015331:Cohort Studies; D003325:Coronary Care Units; D003718:Denmark; D005260:Female; D005500:Follow-Up Studies; D006785:Hospitals, University; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D008297:Male; D009730:Nursing Assessment; D010147:Pain Measurement; D010149:Postoperative Pain / Q000503:physiopathology; D011182:Postoperative Care / Q000379:methods* / Q000451:nursing*; D011446:Prospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D000700:Analgesics; D000928:Antidepressive Agents; D006993:Hypnotics and Sedatives
keywords: Aortic valve stenosis; minimally invasive surgical procedures; nursing; perioperative care; signs and symptoms