Transapical Aortic Valve Implantation
Transapical Aortic Valve Implementation
Transapical aortic valve implantation is a minimally invasive procedure. Even though the procedure is minimally invasive, caution must still be taken to prevent any mishaps. Most patients that have this procedure are older patients who cannot withstand any other type of aortic valve implantation. Severe narrowing of the aortic valve is the main reason for the transapical aortic valve implantation. When this procedure is performed, preparation is extremely important. The procedure generally requires a team consisting of anesthetists, cardiac surgeons and cardiologists. They all must work together to ensure the best outcome for the patient.
Prior to the procedure, the team must go through disciplined training to learn the different steps of the procedure. It is also recommended that the team view an actual transapical aortic valve implementation performed by an experienced team. Once this is done, the team should perform an actual implantation under the supervision of an experienced team. The team should actually perform several of these procedures while under supervision until it is determined by the experts that they have become skilled and work together perfectly as a team. The procedure should be performed in a hybrid operating room with excellent imaging equipment. If this is not possible, a converted cardiac catheterization room is acceptable.
Because the majority of patients having this procedure are elderly, detailed preoperative examinations are a must. These examinations are also considered part of the team preparation. All patients should have cardiac catheterization in order to determine if there are any pressing issues with the arteries. A lung function analysis should also be performed before the procedure and a transthoracic echo is necessary in order to find out if there are any other valve issues. All of these preoperative examinations are imperative and help the team determine whether or not the procedure should be performed or not (Walther et al., 2009).
As with any other type of surgery, whether considered minimally invasive or major surgery complications can arise. Under the supervision of the physician, the nurse will be responsible for most of the perioperative care of the patient. As a result, the nurse must be aware of any and all complications that may arise and must also know how to assist the patient with treatment and management of these medical issues. Some of the common complications that transapical aortic valve implantation patients experience and how they should be treated are as follows:
Allergic reaction to contrast material — Patients should always be screened for allergies beforehand, but if an allergic reaction should occur, the nurse should administer steroids, antihistamines and other airway protection measures.
Infection — Prescreening should always take place before the procedure. A complete history of the patient’s health should be documented along with a dental infections or conditions. After the surgery, the incision should be inspected by the nurse at least twice daily for signs of infection. If an infection does happen, the nurse must clean the incision several times a day and teach the patient to care for the incision before discharge (McRae et al., 2009).
There are numerous other complications that may arise following this procedure and it is important to know that this type of surgery, as with any other type of surgery is not foolproof. However, the success rate can be relatively high if the surgical team performing the operation and the nurse providing the post operative care are both highly trained. It is also important that the patient follow the instructions after discharge to ensure that the recuperation period is speedy and without complications.
McRae, Marion E., Rodger, Marnie, and Barbara A. Bailey. (2009). Transcatheter and transapical aortic valve replacement. Critical Care Nurse, 29(1), 22-37.
Walther, Thomas et. al, (2009). Transapical aortic valve implantation: Step-by-step. The Annals of Thoracic Surgery, 87, 276-283.
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