Baumbusch Jennifer, Lauck Sandra B, Achtem Leslie, O'Shea Tamar, Wu Sarah, Banner Davina
1 School of Nursing, University of British Columbia, Canada.
2 St Paul's Hospital, Vancouver, Canada.
Eur J Cardiovasc Nurs. 2018 Mar;17(3):280-288. doi: 10.1177/1474515117738991. Epub 2017 Oct 31.
Transcatheter aortic valve implantation (TAVI) is the treatment of choice for frail, older adults with severe symptomatic aortic stenosis. Although research about long-term clinical outcomes is emerging, there is limited evidence from the perspectives of patients and family caregivers on their perceived benefits and challenges after TAVI.
The aim of this study was to describe older adults and family caregivers' perspectives on undergoing TAVI at one year post-procedure.
Qualitative description was the method of inquiry. A purposive sample of 31 patients and 15 family caregivers was recruited from a TAVI programme in western Canada. Semi-structured interviews were conducted with participants one year after TAVI. Data were analysed thematically.
All participants were satisfied with the decision to undergo TAVI. There were three central themes. First, recovery was experienced in the context of aging and comorbidities, which was shaped by patients' limited options for care and post-procedure symptom burden. Second, reconciling expectations with reality meant that, for some patients, symptom burden remained prevalent and was also influenced by others' expectations. Third, recommendations for recovery related to having information needs met, keeping informed of evolving care processes, and addressing individualised needs for support.
The perspectives of participants provide a valuable contribution to the literature about undergoing TAVI. Clinicians need to be attentive to patients' expectations of benefit and temper these with consideration of the individual's broader health situation to provide treatment decision support. Patients and family caregivers also need adequate teaching and support to facilitate safe transition home given the shift towards early discharge after TAVI.
经导管主动脉瓣植入术（TAVI）是体弱、老年重度症状性主动脉瓣狭窄患者的首选治疗方法。尽管关于长期临床结果的研究不断涌现，但从患者和家庭护理人员的角度来看，关于TAVI术后他们所感知到的益处和挑战的证据有限。
本研究的目的是描述老年人和家庭护理人员对术后一年接受TAVI的看法。
采用定性描述作为探究方法。从加拿大西部的一个TAVI项目中招募了31名患者和15名家庭护理人员作为有目的的样本。在TAVI术后一年对参与者进行半结构化访谈。对数据进行主题分析。
所有参与者对接受TAVI的决定都很满意。有三个核心主题。首先，康复是在衰老和合并症的背景下经历的，这受到患者有限的护理选择和术后症状负担的影响。其次，使期望与现实相协调意味着，对一些患者来说，症状负担仍然普遍存在，并且也受到他人期望的影响。第三，康复建议包括满足信息需求、了解不断变化的护理过程以及满足个性化的支持需求。
参与者的观点为有关接受TAVI的文献做出了宝贵贡献。临床医生需要关注患者对益处的期望，并结合个体更广泛的健康状况进行调整，以提供治疗决策支持。鉴于TAVI后倾向于早期出院，患者和家庭护理人员也需要充分的教导和支持，以促进安全回家过渡。
