The value of continuous nursing in patients after cardiac mechanical valve replacement.

OBJECTIVE: The purpose of this study was to explore the value of continuous nursing in patients after cardiac valve replacement. METHODS: The clinical data of 116 patients after cardiac mechanical valve replacement from January 2017 to January 2018 were analysed retrospectively. According to the nursing mode, the patients were divided into two groups: the continuous nursing group (group A, n = 56) and the conventional nursing group (group B, n = 60). RESULTS: The continuous nursing group exhibited significantly decreased SAS and SDS scores 1 year after surgery compared to the preoperative SAS and SDS scores(P < 0.05). The SAS and SDS scores of the continuous nursing group were significantly better than those of the traditional nursing group 1 year after surgery(P < 0.05). There were 4 patients with anticoagulant complications after discharge in the continuous nursing group, and 13 cases of anticoagulant complications in the conventional nursing group. There was a significant difference between the two groups. CONCLUSION: Continuous nursing improves patient compliance with treatment and reduces the occurrence of postoperative anticoagulation complications. The patient also receives proper psychological evaluations, which relieve patient anxiety and depression.

Effect of continuous nursing interventions on valve noise-related anxiety and quality of life in patients who underwent mechanical mitral valve replacement.

OBJECTIVE: The purpose of this study was to evaluate the effect of continuous nursing interventions on valve noise-related anxiety in patients undergoing mechanical mitral valve replacement (MVR) and to analyze its impact on patient quality of life. METHODS: Ninety patients who underwent mechanical MVR were divided into two groups. All patients in group A received routine nursing care. In addition to this intervention, an assigned nurse periodically provided patients in group B with continuous nursing interventions and ongoing health consultations during a 1-year follow-up. A hospital anxiety and depression (HAD) scale, a customized questionnaire and a Short Form Health Status 36 (SF-36) score questionnaire were used as the research tools. RESULTS: The postoperative HAD scores were better in group B than in group A, but the differences in most of the data were not statistically significant between the groups, except for HA sections 0-7 and 11-21. Based on the customized questionnaire, the subjective disturbance level was significantly lower in group B than in group A (the results of Q1 and Q4 were statistically significant). With regard to the SF-36 scores, group B was superior to group A in general health, emotional function and mental health, while the other dimensions had no significant difference. CONCLUSIONS: Compared with routine care, patients who received continuous care intervention after mechanical MVR had fewer anxiety symptoms and better quality of life.

Protocolo de enfermagem no implante de valva aórtica transcateter: um direcionamento para o cuidado / Nursing protocol in transcatheter aortic valve implantation: care guideline

Objective: To validate a nursing care protocol by specialist nurses, contributing to the care delivered to patients undergoing percutaneous valve replacement. Methods: This cross-sectional, prospective, quantitative study adopted the Content Validity Index (CVI) to verify level of agreement regarding this protocol's total set of items. Results: The CVI obtained for each item of the protocol, verified using a validation instrument, was greater than the minimum required that is 0.80, on average. Conclusion: The development of a protocol intended to guide care provided to patients who have undergone TAVI, improves patient safety and minimizes health problems, so that the implementation of specific strategies for the development of actions performed by nurses is essential.

Objetivo: Validar un protocolo de cuidados de enfermería por enfermeros especialistas, contribuyendo para la práctica asistencial del paciente sometido al cambio de válvula percutánea. Métodos: Se trata de un estudio metodológico, transversal y prospectivo, con abordaje cuantitativo, que empleó el Índice de Validez de Contenido (CVI) para verificar el nivel de concordancia en el conjunto total de ítems del instrumento del protocolo. Resultados: Después de la verificación con el CVI para cada ítem del instrumento de validación del protocolo, los valores obtenidos en relación a todos los ítems del protocolo, quedaron con los valores, en media, mayores que el mínimo para el CVI, que es arriba de 0,80. Conclusión: El desarrollo de un protocolo de cuidados dirigido para los pacientes sometidos a TAVI, posibilita el aumento de la seguridad del paciente minimiza los daños a la salud, siendo un factor esencial en la implementación de estrategias específicas para el desarrollo de acciones desempeñadas por el enfermero.

Objetivo: Validar um protocolo de cuidados de enfermagem realizado por enfermeiros especialistas, contribuindo para a prática assistencial do paciente submetido à troca valvar percutânea. Métodos: Trata-se de um estudo metodológico, transversal e prospectivo, com abordagem quantitativa, que empregou o Índice de Validade de Conteúdo (IVC) para verificar o nível de concordância no conjunto total de itens do instrumento do protocolo. Resultados: Após a verificação com o IVC, para cada item do instrumento de validação do protocolo, os valores obtidos em relação a todos os itens ficaram, em média, maiores que o mínimo para o IVC, que é acima de 0,80. Conclusão: O desenvolvimento de um protocolo de cuidados, voltado para os pacientes submetidos ao TAVI, possibilita o aumento da segurança destes e minimização dos agravos à saúde, sendo um fator essencial na implementação de estratégias específicas nas ações desempenhadas pelo enfermeiro.

[Percutaneous Edge-to-Edge Mitral Valve Repair: New Transcatheter Approach and Nursing Experience in Patients With Severe Mitral Regurgitation and Prohibitive Surgical Risk].

Open-heart surgery and conservative medical treatments have been the traditional, mainstay treatments for patients with severe mitral regurgitation (MR). Transcatheter edge-to-edge mitral repair is a novel technique. Using the transcatheter approach allows delivery of the clip into the left ventricle and the clipping of the orifice of the MR. The heart failure symptoms and outcomes of patients improve after this procedure. Compared to open-heart surgery, the mitral clip achieves similar MR reduction results with a significantly lower rate of complications. Since 2016, MitraClip has been available for clinical use in Taiwan. The aim of this report is to introduce this new treatment with a focus on nursing care in order to provide a reference for clinical care.

Protocolo de enfermagem no implante de valva aórtica transcateter direcionamento para o cuidado / Nursing protocol in transcatheter aortic valve implantation: a guideline for care

Estudo metodológico, transversal e prospectivo com abordagem quantitativa, abordando os cuidados de enfermagem em pacientes submetidos ao implante de valva aórtica transcateter (TAVI). Para a construção da pesquisa foi realizada uma revisão integrativa para a criação de um protocolo de enfermagem para os pacientes submetidos a TAVI e a validação do mesmo por enfermeiros especialistas utilizando o Índice de Validação de Conteúdo (IVC) em um hospital do Rio de Janeiro. Foi delimitado como questão de pesquisa: quais os cuidados que o enfermeiro realiza nos pacientes submetidos a TAVI? Os objetivos propostos foram: criar um protocolo de cuidados de enfermagem para os pacientes submetidos ao implante de valva aórtica transcateter; buscar evidências científicas para a construção do protocolo através de uma revisão integrativa da literatura; validar o protocolo junto aos enfermeiros especialistas com vistas a validade do conteúdo, pertinência, clareza e abrangência. Para a construção do protocolo foram utilizados 10 artigos em publicações internacionais e nacionais, no período de 2006 a 2016, em inglês e português. A base de dados da Scopus foi a que mais evidenciou artigos representando (50%) das publicações do estudo. O ano de 2015 foi o ano com maior número de publicações (40%). Em relação ao idioma, as publicações em inglês representaram (90%) das publicações. As complicações mais descritas nos artigos foram: insuficiência renal (14,8%), acidente vascular cerebral (12,9%), complicações hemorrágicas (12,9%), complicações vasculares e distúrbios de condução (11,1%), vazamento paravalvar (7,4%), dissecção aórtica (5,5%), infarto agudo do miocárdio, endocardite, tamponamento e perfuração do ventrículo (3,7%), entre outros. Em relação a caracterização do perfil dos enfermeiros especialistas, (56,6%) aderiram ao estudo, o sexo feminino obteve a maior representatividade dos participantes (70,6%), a média da idade dos participantes foi de 35,88 anos. A unidade com maior número de participantes foi a UTI de pós-operatório (88,24%) e o tempo de experiência foi de 2,18 anos, sendo a especialização dos participantes com maior frequência a de Terapia Intensiva com (52,9%). Em relação a validação do conteúdo do protocolo, foi distribuído um instrumento de avaliação que constava com uma escala Likert de 1 a 5, no qual o participante verificava em relação aos itens, a validade do conteúdo, pertinência, clareza e a abrangência. O cálculo foi realizado pelo número de respostas que obtiveram 4 (concordo) e 5 (concordo totalmente) dividido pelo número de participantes (17). A média dos valores em relação a validade do conteúdo 0,96, em relação a pertinência foi de 0,93, clareza 0,86 e a abrangência de conteúdo foi de 0,85. A média de concordância entre todos os itens foi de 0,90. Conclui-se que os objetivos desta pesquisa foram alcançados através da criação e validação de um protocolo de cuidados de enfermagem para pacientes submetidos a TAVI. Acreditamos que pesquisas como esta, possam contribuir para a eficácia das tomadas de decisão do profissional enfermeiro acerca da qualidade do seu atendimento, visando a contribuição na construção de evidências relacionados aos cuidados de enfermagem ao paciente submetido a TAVI.

Methodological, transversal and prospective study with a quantitative approach, addressing nursing care in patients submitted to transcatheter aortic valve (TAVI) implantation. For the construction of the research, an integrative review was carried out for the creation of a nursing protocol for patients submitted to TAVI and validation of it by specialist nurses using the Content Validation Index (IVC) in a hospital in Rio de Janeiro. It was delimited as a research question: what care does the nurse perform in patients undergoing TAVI? The proposed objectives were: to create a nursing care protocol for patients undergoing transcatheter aortic valve implantation; to seek scientific evidence for the construction of the protocol through an integrative literature review; validate the protocol with the specialist nurses for the validity of content, pertinence, clarity and comprehensiveness. For the construction of the protocol, 10 articles were used in international and national publications, from 2006 to 2016, in English and Portuguese. The Scopus database was the one that most evidenced articles representing (50%) of the study publications. The year 2015 was the year with the highest number of publications (40%). In terms of language, English publications represented (90%) of the publications. The complications most described in the articles were: renal failure (14.8%), stroke (12.9%), hemorrhagic complications (12.9%), vascular complications and conduction disorders (11.1%), aortic dissection (5.5%), acute myocardial infarction, endocarditis, tamponade and ventricular perforation (3.7%), among others. Regarding the characterization of the profile of specialist nurses (56.6%), participants were the most representative of the participants (70.6%), the mean age of participants was 35.88 years. The unit with the highest number of participants was the postoperative ICU (88.24%) and the experience time was 2.18 years, with the specialization of the participants being more frequent the Intensive Therapy with (52.9%). In relation to the validation of the content of the protocol, an evaluation instrument was distributed that included a Likert scale of 1 to 5, in which the participant verified in relation to the items, the validity of the content, pertinence, clarity and comprehensiveness. The calculation was performed by the number of responses that obtained 4 (agree) and 5 (totally agree) divided by the number of participants (17). The mean values with respect to content validity of 0.96, relative to relevance was 0.93, clarity 0.86 and content coverage was 0.85. The mean of agreement among all items was 0.90. It is concluded that the objectives of this research were achieved through the creation and validation of a nursing care protocol for patients submitted to TAVI. We believe that research such as this one can contribute to the effectiveness of nursing professional decision-making about the quality of care, aiming to contribute to the construction of evidence related to nursing care to patients submitted to TAVI.

Nursing leadership of the transcatheter aortic valve implantation Heart Team: Supporting innovation, excellence, and sustainability.

Transcatheter Aortic Valve Implantation (TAVI) is an innovative and resource-intensive treatment of valvular heart disease. Growing evidence and excellent outcomes are contributing to increased patient demand. The Heart Team is foundational to TAVI programs to manage the complexities of case selection and other aspects of care. The competencies and expertise of nurses are well suited to provide administrative and clinical leadership within the TAVI Heart Team to promote efficient, effective, and sustainable program development. The contributions of nursing administrative and clinical leaders exemplify the leadership roles that nurses can assume in healthcare innovation.

Integrating a palliative approach in a transcatheter heart valve program: bridging innovations in the management of severe aortic stenosis and best end-of-life practice.

Severe aortic stenosis (AS) is the most prevalent structural heart disease and affects primarily older adults in their last decade of life. If the risk for surgery is high, transcatheter aortic valve implantation (TAVI) is the treatment of choice for many patients with suitable anatomy who are likely to derive significant benefit from this innovative and minimally invasive approach. In a large transcatheter heart valve (THV) centre that offers TAVI as one of the treatment options, of 565 consecutive referrals for the assessment of eligibility for TAVI over 18 months, 78 (14%) were deemed unsuitable candidates for TAVI or higher risk surgery by the interdisciplinary Heart Team because of their advanced disease, excessive frailty or comorbid burden. Concerns were raised for patients for whom TAVI is not an option. The integration of a palliative approach in a THV program offers opportunities to adopt best end-of-life practices while promoting innovative approaches for treatment. An integrated palliative approach to care focuses on meeting a patient's full range of physical, psychosocial and spiritual needs at all stages of a life-limiting illness, and is well suited for the severe AS and TAVI population. A series of interventions that reflect best practices and current evidence were adopted in collaboration with the Palliative Care Team and are currently under evaluation in a large TAVI centre. Changes include the introduction of a palliative approach in patient assessment and education, the measurement of symptoms, improved clarity about responsibility for communication and follow-up, and triggering referrals to palliative care services.

Quality improvement in an anticoagulation clinic: development of a new treatment protocol.

We sought to improve patient outcomes and efficiency in our anticoagulation clinic through development of a new protocol for managing heart valve patients with subtherapeutic international normalized ratio (INR) tests. The new protocol standardized use of 1 anticoagulation agent while warfarin was retitrated, timelines for INR retesting, and target INR levels depending on the type of valve implanted. The new protocol provided significant improvements in patient care; however, outcomes for clinic operating efficiency were mixed.

Patients' discharge experiences: returning home after open-heart surgery.

PURPOSE: This study explored patients' narratives of technology in heart surgery and recovery. METHODS: A narrative inquiry was conducted with a sample of 16 individuals. Interviews were completed 2 to 4 days after transfer from cardiovascular intensive care, and 4 to 6 weeks after discharge. Participants completed journals between these 2 time periods. RESULTS: Discharge and the return home were highlighted as key transitions. These transitions were driven by a technological script that included teachings and texts provided upon discharge. Complicating participants' narratives were their own personal dramas and self-characterizations of vulnerability, as they struggled to incorporate this script into the particularities of their daily lives. CONCLUSION: Comprehensive conceptualizations of technology that involve the associated logics and pathways of recovery provide deep insights into patients' stories of recovery from heart surgery. It is salient that discharge programs consider the ways that technology enters into patients' narratives, and also consider dialogical approaches to communication, education, and supportive interventions that are offered at multiple intervals and continue in the home.

Comparison of effects of manual versus ventilator hyperinflation on respiratory compliance and arterial blood gases in patients undergoing mitral valve replacement.

OBJECTIVE: To compare the effects of manual hyperinflation (MHI) and ventilator hyperinflation (VHI) delivered to completely sedated and paralyzed patients undergoing mitral valve replacement (MVR) while maintaining minute ventilation. METHODS: This was a randomized study with a 2-group, pre-test, post-test experimental design. Effects of hyperinflation were studied on static compliance (C(stat)), dynamic compliance (C(dyn)), oxygenation (Pao(2):Fio(2)), partial pressure of carbon dioxide in arterial blood (Paco(2)), and cologarithm of activity of dissolved hydrogen ions in arterial blood (pH). A sample of 30 patients in the immediate postoperative phase of MVR surgery were included in the study. RESULTS: No significant differences were found between the groups. Significant improvements were found in oxygenation at both 1minute and 20minutes after MHI, but only at 1minute after VHI (P < .05). VHI led to improved C(dyn) (P < .05). CONCLUSION: In the immediate postoperative phase of MVR, both techniques produced similar effects on respiratory compliance and oxygenation. MHI produced longer lasting improvements in oxygenation than VHI, whereas VHI produced better improvements in dynamic compliance. Paco(2) and pH were maintained by both.

Critical review of health-related quality of life studies of patients with aortic stenosis.

BACKGROUND: While studies of health-related quality of life (HRQOL) are increasing among cardiovascular patients, very few have examined HRQOL in persons with aortic stenosis (AS). PURPOSE: A critical review of studies (1997-2008) of HRQOL in persons with AS was conducted to summarize findings and identify clinical and research implications. RESULTS: Twenty-eight studies were identified, all of which were quantitative and evaluated HRQOL after aortic valve replacement (AVR). No studies conducted by nurses or studies measuring HRQOL in persons who did not undergo AVR were found. The literature focused on age and type of valve as variables influencing HRQOL postoperatively. Although results varied, elderly patients often scored similar or better than comparison groups. Health-related quality of life was found to be affected by valve noise and anticoagulation rather than the specific valve type when comparing patients receiving biological versus mechanical valves. CONCLUSIONS: Selection for surgery should not be based on age alone. Early consideration should be given to symptoms prior to surgery because of evidence that patients with fewer symptoms preoperatively have better HRQOL after AVR. Anticoagulation status should be evaluated as an independent variable of HRQOL in future studies. IMPLICATIONS FOR RESEARCH AND PRACTICE: Researchers need to augment generic HRQOL measures with disease-specific items that may pertain to life areas affected by AS, such as audible valve click, wound healing, and dyspnea. Future research should be inclusive of AS patients who do not undergo surgery. Nurses in a variety of roles can work independently or within a multidisciplinary team to provide interventions for the promotion of HRQOL for patients across all stages of the AS disease process.

Factors associated with long hospital length of stay in patients receiving warfarin after cardiac surgery.

BACKGROUND: Patients receiving warfarin therapy after coronary artery bypass graft (CABG) or valve surgery have longer length of stay (LOS) than those not receiving warfarin therapy. Longer LOS increases patient costs, postdischarge recovery time, and rehabilitation. It is important to identify variables of longer postoperative LOS in this patient population so that the healthcare team can develop and facilitate interventions to minimize length of hospitalization. METHODS: Using a hospital registry and medical record review of cases completed in 2004, data from cardiac surgery patients having CABG and/or valve procedures and given warfarin postoperatively were analyzed based on short (<7 days, CABG; 9 days, valve procedure) and long (> or =7 days, CABG; > or =9 days, valve procedure) postoperative LOS. By groups, significant associations were assessed using chi or Fisher exact test for categorical variables and Wilcoxon 2-sample test or Student t test for continuous variables. RESULTS: In 82 patients (33 CABG and 49 valve +/- CABG) who were given warfarin, most demographic, medical history, postoperative complications, and use of cardiac drugs did not predict longer LOS. Longer postoperative LOS was associated with being older (mean age, 73.5 vs 68.5 years), being not married, having postoperative respiratory insufficiency, and receiving more red blood cell transfusions, all P < .05; and having more healthcare consultations, longer critical care stay, and longer time between surgery date and start of warfarin; all P < .001. CONCLUSIONS: Variables associated with longer LOS were nonmodifiable by nursing services and were difficult to assess preoperatively. They primarily involved intraoperative or postoperative bleeding that led to red blood cell infusion and longer critical care stays that delayed warfarin initiation. However, older age and marital status are nursing targets because they may be associated with social isolation and other psychosocial issues. Transition of care programs can be developed to promote earlier discharge.

Estudo comparativo da evolução em longo prazo da valvoplastia mitral com a técnica de Inoue versus a do balão único / Comparative study of long-term outcomes of Inoue ballon and single ballon in mitral valvuloplasty

Diferentes técnicas de balão têm custo diverso e podem ter evolução diferente. Comparar a evolução da valvoplastia mitral realizada com a técnica de Inoue e com a do balão único, verificando se a técnica é fator de risco independente para óbito ou eventos maiores e determinar na população total, variáveis independentes para óbito e eventos maiores e determinar na população total, variáveis independentes para óbito e eventos maiores. Métodos: Foi usando o balão de Inoue em 54 (17,4 por cento) pacientes e o balão único em 256 (82,6 por cento) pacientes. Seguimento: grupo do balão de Inoue de 33 + - 27 meses, e do balão único de 55 + - 33 meses (p=0,0001). Resultados: encontrou-se na evolução, no grupo do balão de Inoue...

Transcatheter and transapical aortic valve replacement.

Minimally invasive valve replacement is limited to bioprosthetic aortic and pulmonary valves for use in very specific populations of patients. Replacement via trans-catheter and transapical techniques should be used only in patients in whom traditional surgical replacement is deemed an unacceptable risk. Nursing management will focus heavily on care for comorbid conditions because of the high-risk nature of the patients in whom these valves will initially be implanted.

Mitral valve replacement: a case report.

Mitral regurgitation is commonly encountered in anesthesia clinical practice. Knowledge of the pathophysiology and proper anesthetic management is crucial to achieving optimal outcomes. Surgical advancements and early intervention have led to improved outcomes. An ASA class III, 58-year-old woman with mitral regurgitation secondary to rheumatic fever, presented for repair or replacement of the mitral valve. A graded induction with low-dose narcotic, isoflurane, and phenylephrine was required to maintain acceptable cardiovascular parameters during induction and throughout the case. Additional interventions included adequate preload, normal heart rate, and decreased afterload, to maintain a mean arterial pressure of 65 mm Hg. Ampicillin and gentamicin were administered according to American Heart Association guidelines for prophylactic management against subacute bacterial endocarditis. Milrinone and epinephrine were required for inotropic support until the left ventricle recovered from ischemic time. Milrinone was an ideal inotrope in this case, as its vasodilator properties allowed an increase in forward flow with minimal impact on pulmonary hypertension. Goals for the anesthetist include preservation of forward flow with minimal regurgitation and decreased pulmonary congestion. Invasive monitoring and transesophageal echocardiography have improved diagnostics and anesthetic management.

The effect of music listening on older adults undergoing cardiovascular surgery.

The purpose of this study was to determine the effect of music listening on postoperative anxiety and intubation time in patients undergoing cardiovascular surgery. Coronary artery disease and valvular heart disease affect approximately 15 million Americans and 5 million persons in the U.K. annually, with the majority of these patients being older adults. The anxiety experienced before, during and after surgery increases cardiovascular workload, thereby prolonging recovery time. Music listening as a nursing intervention has shown an ability to reduce anxiety. The study used a randomized control trial design. Sixty adults older than 65 years were randomly assigned to the control and the experimental groups. The experimental group listened to music during and after surgery, while the control group received standard postoperative care. The Spielberger State Trait Anxiety Inventory was administered to both groups before surgery and 3 days postoperatively. The mean of the differences between scores was compared using analysis of variance. Differences in mean intubation time were measured in both groups. Older adults who listened to music had lower scores on the state anxiety test (F = 5.57, p = .022) and had significantly fewer minutes of postoperative intubation (F = 5.45, p = .031) after cardiovascular surgery. Older adults undergoing cardiovascular surgery who listen to music had less anxiety and reduced intubation time than those who did not.