Mohammadi Mina, Hill Catherine, Chaney Susan
College of Nursing, Texas Woman's University, Dallas, Texas.
J Am Assoc Nurse Pract. 2016 Jul;28(7):387-92. doi: 10.1002/2327-6924.12338. Epub 2016 Jan 5.
This article's purpose is to make advanced practice nurses (APNs) aware of a minimally invasive transcatheter aortic valve replacement (TAVR) for treating symptomatic severe aortic valve stenosis in elderly patients. These patients are not safe surgical candidates because of their age and prohibitive risk profile, but they can benefit from valve replacement.
A systematic literature review was completed by searching online databases such as CINAHL, PubMed, and Google. Research articles from 2008 to 2014 were retrieved from various medical journals such as The American Journal of Cardiology, Yale Journal of Biology and Medicine, Journal of the American Medical Association, and New England Journal of Medicine. Key words used in the search were aortic valve replacement, elderly patients, and severe aortic stenosis (AS).
Minimally invasive TAVR is highly superior to the medical treatment including aortic valvuloplasty and is noninferior to the surgical aortic valve replacement for the treatment of symptomatic severe aortic valve stenosis in elderly patients who are not safe surgical candidates.
APNs have the education and skills to diagnose AS. Hence, they should stay abreast of new treatments and provide safe care and referrals for their patients diagnosed with severe AS.
本文旨在让高级执业护士（APN）了解一种用于治疗老年患者症状性严重主动脉瓣狭窄的微创经导管主动脉瓣置换术（TAVR）。由于年龄和极高的风险状况，这些患者并非手术的安全候选人，但他们可从瓣膜置换中获益。
通过检索CINAHL、PubMed和谷歌等在线数据库完成系统的文献综述。从《美国心脏病学杂志》《耶鲁生物学与医学杂志》《美国医学会杂志》和《新英格兰医学杂志》等各种医学期刊中检索2008年至2014年的研究文章。检索中使用的关键词为主动脉瓣置换、老年患者和严重主动脉狭窄（AS）。
对于并非手术安全候选人的老年患者，在治疗症状性严重主动脉瓣狭窄方面，微创TAVR远优于包括主动脉瓣成形术在内的药物治疗，且不劣于外科主动脉瓣置换术。
APN具备诊断AS的知识和技能。因此，他们应跟上新的治疗方法，并为诊断为严重AS的患者提供安全的护理和转诊服务。
