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.

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.

A patient's bold voice: a journey through cardiac surgery

Cardiac surgery is one of the most common operations performed on adults. The physiology, pathophysiology, pharmacology, and technologies relating to this complex patient population are researched and discussed frequently in critical care journals. Most of this article is written by a patient who has had cardiac surgery, specifically an aortic valve replacement. The patient shares his journey from diagnosis to recovery. The discussion includes the discovery and monitoring of aortic regurgitation, surgical options, valve replacement surgery, postoperative pericarditis, pain, family and visitors, and life on warfarin. The current practice is reviewed by the patient's wife, a critical care clinical nurse specialist. When we really listen to the patient, we can learn how to provide more holistic and humanistic care.

[Incidence and prevalence of postoperative acute confusion in heart surgery patients after coronary artery bypass and heart valve replacement surgeries]

Compared to foreign countries, Germany does not have data about the occurrence of acute confusion following heart-surgery. However, the occurrence of acute confusion does extend the hospital length of stay for up to 13 days. Thus, this phenomenon is of high relevance to nursing. This prevalence/incidence study was implemented with the goal of obtaining exact information on the incidence rate of acute postoperative confusion after a heart surgery through a multicenter evaluation. The data evaluation took place in the form of a convenience sample survey in three different German clinics specializing on heart surgeries. The observation period lasted from the day of the surgery up to the fifth postoperative day. In the context of this prospective Cohort-study all patients aged 18 and older who had heart surgery between February 1st and April 30th, 2000, were considered suitable as participants in the study. In the end, 860 patients were included in this study. 152 patients (17.4%) showed symptoms of acute confusion (confidence interval 14-20%). Certain circumstances seemed to predispose patients to acute confusion. A widespread occurrence could be observed particularly at night. Patients aged 81-91 were mainly affected. A confusion rate of 43.5% could be determined for this group. These results confirm the clinical importance and suggest interdisciplinary approaches for solution.

Aortic valve replacement

From hospital to home care, patients receiving prosthetic valves benefit from nurses who understand their condition and know the essentials for avoiding complications of the procedure--and the anticoagulant therapy they may be on for a lifetime.

Gender and short-term recovery from cardiac surgery

BACKGROUND

There has been a lack of agreement regarding whether women have poorer outcomes than men following cardiac surgery.

OBJECTIVES

To examine the effect of gender on early recovery from cardiac surgery.

METHOD

Using a prospective descriptive design, 60 men and 60 women who had coronary artery bypass and/or valve surgery completed the study by participating in interviews in the immediate preoperative period and monthly through the third postoperative month. Measures of life quality, life satisfaction, expected/perceived recovery, functional status, global health status, and social support were examined.

RESULTS

Preoperatively, women were more functionally limited (p = 0.019), and reported lower life satisfaction (p = 0.001) and social support (p = 0.006), than men. At 3 months postoperatively, there were few significant differences in outcome measures though women continued to report lesser social support (p = 0.002); women realized significantly greater improvement than men in functional status (p = 0.008); and neither age nor gender consistently predicted recovery.

CONCLUSIONS

Recent studies focusing on gender differences in cardiac surgery recovery indicate fewer differences between men and women than once thought. However, the differences identified in this study (women's significantly greater improvement in functional status, lesser social support, and differences in the nature of work to which women return following their surgery) warrant concern and attention in clinical practice.

Telephone monitoring after early discharge for cardiac surgery patients

BACKGROUND

Monitoring the postoperative course of cardiac surgery patients remains essential but requires creative strategies now that length of hospitalization has been shortened to 5 days or less.

OBJECTIVES

To determine patients' concerns in the early recovery period after open-heart surgery and to describe the impact of advanced practice nurses on this phase of recovery.

METHOD

A cardiovascular clinical nurse specialist conducted follow-up by telephone for 342 cardiac surgery patients 7 to 14 days after discharge. Patients were asked both open-ended and direct questions.

RESULTS

The major problems were leg edema (48%), appetite disturbance (35%), dyspnea (29%), sleep disturbance (12%), and wound drainage (9%). The nurse's interventions over the telephone included reassuring the patient about postoperative progress (86% of sample), giving diet information (31%), instructing about activity (29%), providing emotional support (25%), referring for medical treatment (16%), and explaining medications (13%). In response to these findings, the nursing practice council revised postoperative teaching to emphasize wound healing, sleep, and appetite issues.

CONCLUSIONS

Telephone monitoring of cardiac surgery patients after early discharge can alleviate the often stressful transition to postoperative recovery at home. A cardiovascular clinical nurse specialist can provide patients and patients' family members with reassurance and ongoing reinforcement of the discharge information.

On the horizon: minimally invasive cardiac surgery

The landscape of cardiac surgery is changing. Advances in endoscopic and other instrumentation procedures such as port access, video instrumentation, and computer-assisted technology are opening new vistas for cardiac surgery. On the immediate horizon is minimally invasive cardiac surgery, also known as keyhole surgery. Imagine a patient not needing a median sternotomy incision or cardiopulmonary bypass. This new type of cardiac surgery is currently being explored at some cardiac surgical centers internationally. This article explores the current state-of-the-art related to minimally invasive direct coronary artery bypass surgery. The operative procedure, implications for perioperative nursing care, likely future technologies, and the research literature on outcomes are also discussed.