Aortic Valve Disease and Trans-catheter Aortic Valve Replacement - - PowerPoint PPT Presentation

Aortic Valve Disease and Trans-catheter Aortic Valve Replacement

“The Latest Treatment Option”

Sonia Scalf, RN, CVSN Structural Heat Nurse Coordinator Vanderbilt Heart and Vascular Institute

Aortic Stenosis

 Aortic stenosis is the most important

cardiac valve disease in developed countries, affecting 3 percent of persons

• lder than 65 years.

 Aortic valve replacement is the only

effective treatment for patients with severe symptomatic aortic stenosis.

What is Aortic Stenosis?

Aortic stenosis: is a buildup of calcium deposits in the valve, which causes it to narrow and reduce blood flow to the rest of your body.

Types of Aortic Stenosis

Aortic Stenosis is Progressive

• Mild to severe

symptoms

• Asymptomati

c

• Mild

symptoms

• Asymptomati

c

• Asymptomati

c

• Asymptomati

c

Healthy Mild Severe Moderate

What are the Symptoms of Aortic Stenosis?

Symptoms of aortic valve disease are commonly misunderstood by patients as normal signs of aging.

Most Common Symptoms  Shortness of breath  Fatigue  Difficulty walking short

distances

 Dizziness or passing out  Swollen ankles, feet and

legs

 Chest Pain  Lack of motivation to

participate

 Fast heartbeat

Blase A Carabello, Walter J Paulus Lancet 2009; 373: 956–66

What’s the big deal? 80 year olds are supposed to be tired, right?

5-Year Survival

8 Breast Cancer Lung Cancer Colorectal Cancer Prostate Cancer Ovarian Cancer Severe Inoperable AS*

Survival, %

Said another way…

Nkomo et al. Lancet 2006; 368: 1005–11

The Prevalence of Aortic Stenosis Increases with Age

How Do You Get Diagnosed?

Echocardiography (ECHO) How often should you have an ECHO An echocardiogram (echo) can confirm your symptoms and tell how severe your stenosis.

 It's also an important test

to help monitor aortic valve stenosis over time.

 Mild

Every 3 to 5 years

 Moderate Every 1 to 2

years

 Severe

Every 6 to 12

Other T est to Diagnose Aortic Stenosis

 Auscultation

• A stethoscope is used to listen to te sounds of your

heart which may detect a murmur

 Chest X-Ray

• An x-ray of your chest can reveal calcium deposits on

your aortic valve

 Cardiac Catheterization

• This is a test where dye is injected in your heart

through your arm or groin and measurements are taken across the aortic valve

 CT scans/MRI

• This is imagig that can show how calcified the aortic

valve leaflets are

The Heart Valve T eam

It takes a specialized and dedicated team to decide which treatment

• ption is right for you

Which Is Best For You?

Surgical Aortic Valve Replacement (SAVR) Transcathter Aortic Valve Replacement (TAVR)

Surgical Aortic Valve Replacement (SAVR)

 Typically requires incision

across the full length of the breast bone

 Requires heart lung machine  Disease aortic valve is

completely removed

 Typically associated with

longer hospital stay and longer recovery

Trans-cather Aortic Valve Replacement (TAVR)

 Catheter based

technique that is performed while the heart is still beating

 May be a better

alternative for those who are at intermediate risk for

• pen heart surgery

 Typically associated

with shorter hospital stay and recovery time

TAVR Patients Suffer Less Repeat Hospitalization

Edwards SapienValve

How is TAVR Performed?

 Trans-femoral is the most

common approach (access via upper leg, groin area)

 An alternative access

approach is available for patients with vascular access issues

TAVR Procedure

Who is Eligible for TAVR *People with symptomatic severe aortic stenosis who are intermediate risks are greater risks for mortality for open heart surgery as determined by a specialized heart team

TAVR Evaluation: What to Expect

 Initial contact with the

TAVR nurse coordinator. This person who will be with you before during and after surgery

 This person will explain

the process and be easily accessible to you and your family

TAVR Evaluation Process

 Interventional Cardiologist in clinic  Two Separate clinic visits with Cardiac surgeons  Echocardiogram (may or may not need to be

repeated)

 Pulmonary function tests  Frailty tests  Carotid ultrasound  Dental exam  CT angiogram of chest abdomen and pelvis  Cardiac catheterization  Lab work  Electrocardiogram

Valve Class: Preparation for surgery

 One on one or small group pre op TAVR

class

• TAVR coordinator/educator

 Valve biinder: What to expect pre and

post op including at home

 What medications to hold and how long

to hold them

 Antibacterial scrubs  Answer any last minute questions or

concerns

Support System: Before and After Patient and family support

• Education from heart team
• Teaching from heart team
• Social worker
• Cardiac rehab

Community support

• Mended Hearts – make sure family and

patient aware of support group

• Out-patient cardiac rehab

Working Together to Improve the Quality of Life