Transcatheter Aortic Valve Replacement: Clinical Update for Nurse Practitioners

      Highlights

      • Aortic stenosis affects more than 2% of the United States population.
      • Early identification and shared decision making of treatment options is essential to quality care.
      • Treatment for aortic stenosis includes transcatheter aortic valve replacement.
      • Nurse practitioner are key members of the patient’s health care team.

      Abstract

      Aortic stenosis is one of the most prevalent types of valvular heart disease in the United States, and nurse practitioners in multiple practice settings can play a vital role in the care of these patients. Early identification and treatment are key to improved patient outcomes. Treatment options have advanced over the last decade and include a less invasive procedure called transcatheter aortic valve replacement. The purpose of this article is to improve nurse practitioner’s knowledge of aortic stenosis, discuss treatment options with a focus on transcatheter aortic valve replacement, and provide their patients with an improved quality and longevity of life.

      Keywords

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      References

        • Hawkey M.C.
        • Perpetua E.M.
        • Lauck S.
        • Simone A.
        Transcatheter Aortic Valve Replacement Program Development: A Guide for the Heart Team.
        Wolters Kluwer, 2020
        • Carita P.
        • Coppola G.
        • Novo G.
        • et al.
        Aortic stenosis: insights on pathogenesis and clinical implications.
        J Geriatr Cardiol. 2016; 13: 489-498
        • Estes B.A.
        • Kalra A.
        Contemporary nursing care in transcatheter aortic valve replacement.
        J Vasc Nurs. 2018; 36: 186-188
        • Bevan G.
        • Al-Kindi S.
        Epidemiology and trends of aortic stenosis mortality in the United (1999-2016).
        J Am Coll Cardiol. 2019; 73: 1972
        • Leon M.B.
        • Smith C.R.
        • Mack M.
        • et al.
        Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery.
        N Engl J Med. 2010; 363: 1597-1607
        • Everett R.J.
        • Clavel M.A.
        • Pibarot P.
        • Dweck M.R.
        Timing of intervention in aortic stenosis: a review of current and future strategies.
        Heart. 2018; 104: 2067-2076
        • Bavaria J.E.
        • Tommaso C.L.
        • Brindis R.G.
        • et al.
        2018 AATS/ACC/SCAI/STS Expert consensus systems of care document: operator and institutional recommendations and requirements for transcatheter aortic valve replacement. A joint report of the American Association for Thoracic Surgery, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons.
        J Am Coll Cardiol. 2019; 73: 340-374
        • Akahori H.
        • Tsujino T.
        • Masuyama T.
        • Ishihara M.
        Mechanisms of aortic stenosis.
        J Cardiol. 2018; 71: 215-220
      1. Mahmaljy HT, A. Young, M. Transcatheter Aortic Valve Replacement. StatPearls. 2020. Accessed January 21, 2021. https://www.ncbi.nlm.nih.gov/books/NBK431075

        • Barbash I.M.
        • Waksman R.
        Overview of the 2011 Food and Drug Administration Circulatory System Devices Panel of the Medical Devices Advisory Committee Meeting on the Edwards SAPIEN transcatheter heart valve.
        Circulation. 2012; 125: 550-555
        • Carroll J.D.
        • Mack M.J.
        • Vemulapalli S.
        • et al.
        STS-ACC TVT registry of transcatheter aortic valve replacement.
        J Am Coll Cardiol. 2020; 76: 2492-2516
        • American Association of Nurse Practitioners
        AANP National Nurse Practitioner Database. 2020.
        (Accessed October 6, 2021)
        • Singh G.K.
        Congenital aortic valve stenosis.
        Children (Basel). 2019; 6: 69
        • Oliver-McNeil S.
        Management of valvular heart disease in adults: implications for nurse practitioner practice.
        J Nurse Pract. 2019; 15: 65-72
        • Gewitz M.H.
        • Baltimore R.S.
        • Tani L.Y.
        • et al.
        Revision of the Jones Criteria for the diagnosis of acute rheumatic fever in the era of Doppler echocardiography: a scientific statement from the American Heart Association.
        Circulation. 2015; 131: 1806-1818
        • Mohammadi M.
        • Hill C.
        • Chaney S.
        Is transcatheter aortic valve replacement a safe treatment for elderly patients with severe aortic valve stenosis?.
        J Am Assoc Nurse Pract. 2016; 28: 387-892
        • Yadgir S.
        • Johnson C.O.
        • Aboyans V.
        • et al.
        Global, regional, and national burden of calcific aortic valve and degenerative mitral valve diseases, 1990-2017.
        Circulation. 2020; 141: 1670-1680
        • Deal K.
        • Schofield D.L.
        Preoperative evaluation of aortic stenosis patient.
        J Nurse Pract. 2019; 15: 41-46
        • Goody P.R.
        • Hosen M.R.
        • Christmann D.
        • et al.
        Aortic valve stenosis: from basic mechanisms to novel therapeutic targets.
        Arterioscler Thromb Vasc Biol. 2020; 40: 885-900https://doi.org/10.1161/ATVBAHA.119.313067
        • Banovic M.
        • Athithan L.
        • McCann G.P.
        Aortic stenosis and diabetes mellitus: an ominous combination.
        Diab Vasc Dis Res. 2019; 16: 310-323
        • Yu J.
        • Kern M.
        What type of AS does your patient have? Sorting out differences in the low-flow, low gradient severe AS patient.
        Cath Lab Digest. 2018; 26
        • Otto C.M.
        • Nishimura R.A.
        • Bonow R.O.
        • et al.
        2020 ACC/AHA guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines.
        J Am Coll Cardiol. 2021; 77: 450-500
        • Malik A.
        • Brito D.
        • Chhabra L.
        Congestive Heart Failure.
        StatPearls, 2020 (Accessed January 17, 2021)
        • Siliste R.-N.S.
        • Siliste C.
        Physical examination in aortic valve disease: do we still need it in the modern era?.
        E-J Cardiol Pract. 2020; 18
      2. Gersh BJ. Physiologic and pharmacologic maneuvers in the differential diagnosis of heart murmurs and sounds. UpToDate, 2021.

        • Singh P.K.
        • Jangpangi G.
        Visible pulsus parvus et tardus in patient of aortic stenosis.
        BMJ Case Reports. 2017; (2017:bcr-2017-221034)
        • Kumar V.
        • Sandhu G.S.
        • Harper C.M.
        • Ting H.H.
        • Rihal C.S.
        Transcatheter aortic valve replacement programs: clinical outcomes and developments.
        J Am Heart Assoc. 2020; 9e015921
        • Mack M.J.
        • Leon M.B.
        • Thourani V.H.
        • et al.
        Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients.
        N Engl J Med. 2019; 380: 1695-1705
        • Popma J.J.
        • Deeb G.M.
        • Yakubov S.J.
        • et al.
        Transcatheter aortic-valve replacement with a self-expanding valve in low-risk patients.
        N Engl J Med. 2019; 380: 1706-1715
        • Brennan J.M.
        • Thomas L.
        • Cohen D.J.
        • et al.
        Transcatheter versus surgical aortic valve replacement: Propensity-matched comparison.
        J Am Coll Cardiol. 2017; 70: 439-450https://doi.org/10.1016/j.jacc.2017.05.060
        • Steiner J.M.
        • Cooper S.
        • Kirkpatrick J.N.
        Palliative care in end-stage valvular heart disease.
        Heart. 2017; 103: 1233
        • Lauck S.B.
        • McGladrey J.
        • Lawlor C.
        • Webb J.G.
        Nursing leadership of the transcatheter aortic valve implantation Heart Team: supporting innovation, excellence, and sustainability.
        Healthc Manage Forum. 2016; 29: 126-130
        • Otto C.M.
        • Kumbhani D.J.
        • Alexander K.P.
        • et al.
        2017 ACC expert consensus decision pathway for transcatheter aortic valve replacement in the management of adults with aortic stenosis: a report of the American College of Cardiology task force on clinical expert consensus documents.
        J Am Coll Cardiol. 2017; 69: 1313-1346
        • Antonides C.F.J.
        • Mack M.J.
        • Kappetein A.P.
        Approaches to the role of the heart team in therapeutic decision making for heart valve disease.
        Structural Heart. 2017; 1: 249-255
        • Karycki M.K.
        Transcatheter aortic valve replacement.
        Nursing. 2019; 49: 24-31
        • Haight K.
        Caring for patients after transcatheter aortic valve replacement: understanding options for patients helps you be a more effective caregiver.
        Am Nurse Today. 2017; 12: 10-16
        • Gurevich S.
        • Oestreich B.
        • Kelly R.F.
        • et al.
        Outcomes of transcatheter aortic valve replacement using a minimalist approach.
        Cardiovasc Revasc Med. 2018; 19: 192-195
        • American College of Cardiology
        Transcatheter Heart Valve Handbook: A Surgeon’s and Interventional Council Review, 2018.
        (Accessed February 7, 2021)
        • Brouwer J.
        • Nijenhuis V.J.
        • Delewi R.
        • et al.
        Aspirin with or without clopidogrel after transcatheter aortic-valve implantation.
        N Engl J Med. 2020; 383: 1447-1457

      Biography

      Christina Cantey, MSN, CRNP, is a certified family nurse practitioner in structural cardiology and is the valve program coordinator at Huntsville Hospital Health System, Huntsville, AL, and can be reached at [email protected] .