Valvular Heart Disease: A Guide for Cardiovascular Nurses and Allied Health Professionals 3030862321, 9783030862329

Table of contents :
Contents
Introduction
Valvular Heart Disease
Experts Needed: Opportunities for Clinical Leadership
A Unique Resource for a New Field of Practice
A Team of International “Practice-Close” Leaders
About the Contributors
Part I: Understanding Valvular Heart Disease
1: Acquired Valvular Heart Disease: Overview of Patient Population
1.1 Objectives
1.2 Challenges Associated with the Care of Patients with Valvular Heart Disease
1.3 Acquired Valvular Heart Disease Pathologies
1.3.1 Aortic Stenosis
1.3.1.1 Age and Gender
1.3.1.2 Etiology and Risk Factors
1.3.1.3 Comorbid Conditions
1.3.2 Aortic Regurgitation
1.3.2.1 Age and Gender
1.3.2.2 Etiology and Risk Factors
1.3.2.3 Comorbid Conditions
1.3.3 Mitral Regurgitation
1.3.3.1 Age and Gender
1.3.3.2 Etiology and Risk Factors
1.3.3.3 Comorbid Conditions
1.3.4 Mitral Stenosis
1.3.4.1 Age and Gender
1.3.4.2 Etiology and Risk Factors
1.3.4.3 Comorbid Conditions
1.3.5 Tricuspid Regurgitation
1.3.5.1 Age and Gender
1.3.5.2 Etiology and Risk Factors
1.3.5.3 Comorbid Conditions
1.4 Key Takeaways
References
2: Anatomy and Pathophysiology of Valvular Heart Disease
2.1 Objectives
2.2 Background
2.3 Anatomy and Physiology
2.3.1 Normal Anatomy
2.3.1.1 Semilunar Valves
Pulmonary Valve
Aortic Valve
2.3.1.2 Atrioventricular Valves
Tricuspid Valve
Mitral Valve
2.3.2 Normal Physiology
2.4 Etiologies and Pathogenesis of Acquired VHD
2.4.1 Rheumatic heart disease
2.4.1.1 Epidemiology
2.4.1.2 Pathogenesis
2.4.1.3 Presentation
2.4.2 Non-rheumatic Valve Disease
2.4.2.1 Infective Endocarditis
Epidemiology
Pathogenesis
Presentation
2.4.2.2 Degenerative Valve Disease
Epidemiology
Pathogenesis
2.4.2.3 Calcific Valve Disease
Epidemiology
Pathogenesis
2.5 Aortic Valve Disease
2.5.1 Aortic Stenosis
2.5.1.1 Etiology and Pathoanatomy
2.5.1.2 Pathophysiology
2.5.1.3 Clinical Manifestations
2.5.1.4 Physical Assessment
2.5.2 Aortic Regurgitation
2.5.2.1 Etiology and Pathoanatomy
2.5.2.2 Pathophysiology
2.5.2.3 Clinical Manifestations
2.5.3 Physical Assessment
2.6 Mitral Valve Disease
2.6.1 Mitral Stenosis
2.6.1.1 Etiology and Pathoanatomy
2.6.1.2 Pathophysiology
2.6.1.3 Clinical Manifestations
2.6.1.4 Physical Assessment
2.6.2 Mitral Regurgitation
2.6.2.1 Etiology and Pathoanatomy
Primary Mitral Regurgitation
Secondary mitral regurgitation
2.6.2.2 Pathophysiology
Clinical Manifestations
2.6.2.3 Physical Assessment
2.7 Tricuspid Valve Disease
2.7.1 Tricuspid Regurgitation
2.7.2 Etiology and Pathoanatomy
2.7.3 Pathophysiology
2.7.4 Clinical Manifestations
2.7.5 Physical Assessment
2.7.6 Tricuspid Stenosis
2.8 Summary
2.9 Key Takeaways
References
Part II: Valvular Heart Disease Program Structure
3: The Heart Team: A Gold Standard of Care
3.1 Objectives
3.2 Introduction
3.3 The Pre-Procedure Heart Team
3.3.1 Team Members
3.3.1.1 Valve Program Clinician
3.3.1.2 Interventional Cardiologists and Cardiac Surgeons
3.3.1.3 Cardiac Imaging Specialists
3.3.1.4 Advanced Practice Nurses
3.3.1.5 Geriatric Medicine and Palliative Approach Specialists
3.3.2 Strategies to Strengthen the Impact of the Pre-Procedure Heart Team
3.4 The Peri-Procedure Heart Team
3.4.1 Team Members
3.4.1.1 Procedural Cardiologists and Cardiac Surgeons
3.4.1.2 Nursing and Allied Health Professional Team
3.4.1.3 Anesthesiology Services
3.4.2 Strategies to Strengthen the Impact of the Peri-Procedure Heart Team
3.5 The Post-Procedure Heart Team
3.5.1 Team Members
3.5.1.1 Critical Care and Cardiac Telemetry Nurses
3.5.1.2 Nurse Practitioners and Advanced Practice Providers
3.5.1.3 Specialized Medical Services: Electrophysiology
3.5.2 Strategies to Strengthen the Impact of the Post-Procedure Heart Team
3.6 Conclusion
3.7 Key Takeaways
References
4: Processes of Care and Evaluation Pathway for Patients with Valvular Heart Disease
4.1 Evaluation Pathway: Structure and Processes
4.2 Patient Pathway
4.3 Diagnostic Testing and Evaluations
4.3.1 History and Physical Examination
4.3.2 Transthoracic Echocardiogram
4.3.3 Transesophageal Echocardiogram
4.3.4 Dobutamine Stress Echocardiogram
4.3.5 Electrocardiogram
4.3.6 Computerized Tomography Scan
4.3.7 Coronary Angiography
4.3.8 Carotid Ultrasound
4.3.9 Pulmonary Function Testing
4.3.10 Blood Work
4.3.11 Dental Clearance
4.3.12 Functional and Cognitive Assessments
4.3.12.1 5 Meter Walk Test (5MWT)
4.3.12.2 6-Minute Walk Test (6MWT)
4.3.12.3 Kansas City Cardiomyopathy Questionnaire (KCCQ-12)
4.3.12.4 Mini Mental State Examination (MMSE)
4.3.12.5 Surgical and Procedural Risk Evaluation
4.3.13 Anesthesia Assessment
4.4 Putting It All Together: Making Balanced Treatment Decisions
References
Part III: Assessing Valvular Heart Disease
5: Imaging Modalities in the Diagnosis and Treatment of Acquired Heart Valve Disease
5.1 Background
5.2 Diagnostic and Imaging Modalities
5.2.1 Electrocardiogram (ECG)
5.2.2 Chest Radiography (CXR)
5.2.3 Echocardiography
5.2.3.1 Transthoracic Echocardiogram (TTE)
5.2.3.2 Transesophageal Echocardiography (TEE)
5.2.3.3 Nursing Considerations
5.2.3.4 Three-Dimensional Echocardiography (3DE)
5.2.4 Cardiac Catheterization
5.2.5 Multidetector Computed Tomography (MDCT)
5.2.5.1 Nursing Considerations
5.2.6 Cardiac Magnetic Resonance
5.2.6.1 Nursing Considerations
5.2.7 Exercise Testing
5.2.7.1 Nursing Considerations
5.2.7.2 Serial Testing of Patients with VHD
5.3 Mitral Regurgitation
5.3.1 Preprocedural/Procedural Imaging
5.3.2 Procedural Considerations
5.3.2.1 Edge to Edge
5.3.2.2 Minimally Invasive and Robotic Mitral Valve Surgery
5.3.2.3 After Edge-to-Edge Repair
5.4 Mitral Stenosis
5.5 Aortic Regurgitation
5.5.1 Intraprocedural Imaging
5.6 Aortic Stenosis
5.6.1 Stress Echo
5.6.2 Transcatheter Aortic Valve Replacement
5.7 Tricuspid Regurgitation
5.7.1 Intraoperative Assessment
5.8 Tricuspid Stenosis
5.9 Summary
References
6: Measuring Function, Frailty and Quality of Life in People with Heart Valve Disease
6.1 Introduction
6.1.1 Clinical Case
6.2 Functionality
6.3 Frailty
6.3.1 Understanding Frailty
6.3.2 Measuring Frailty
6.3.3 Frailty in Patients with Symptomatic Aortic Stenosis
6.3.4 Frailty and Implications for Treatment
6.4 Quality of Life
6.4.1 Measuring Quality of Life
6.4.2 Integrating the Measurement of Quality of Life in Clinical Care
6.5 Conclusion
References
7: Making a High-Quality Treatment Decision: Shared Decision-Making
7.1 Background
7.2 Shared Decision-Making
7.2.1 Creating the Foundation
7.2.1.1 A Disruptive Practice
7.2.1.2 Conceptual and Education Foundations
7.2.2 Shaping Meaningful Conversation
7.2.2.1 Addressing Health Disparities
7.2.2.2 Unique Considerations in Valvular Heart Disease
7.2.2.3 Multiple Treatment Options
7.2.2.4 Goals and Preferences
7.3 Eliciting Patient Goals
7.3.1 Choices for a Life Time
7.3.2 Opening the Conversation
7.3.3 Patient Decision Aids
7.4 Influencing Change
7.4.1 The Right Competencies
7.5 Conclusion
References
Part IV: Valvular Heart Disease Treatment Options
8: Surgical Treatment for Patients with Valvular Heart Disease
8.1 Heart Valve Surgery: An Introduction
8.2 The Multiple Moving Parts of the Careful Preparation for Heart Valve Surgery
8.2.1 Before Heart Valve Surgery: Nursing Procedures and Observations in the Operating Room
8.2.2 Role of Nurses in the Peri-Operative Heart Valve Surgery Team
8.2.3 Preparing Patients for Heart Valve Surgery
8.3 An Overview of Heart Valve Surgery Procedures
8.3.1 Before the Valve: The Preliminary Steps of Heart Valve Surgery
8.3.1.1 Exposing the Heart
8.3.1.2 Bypassing Cardiovascular Circulation
8.3.1.3 Stopping the Heart
8.3.1.4 Anesthesia
8.3.1.5 Choosing the Right Valve for the Right Patient
8.3.2 During Heart Valve Surgery: Nursing Procedures and Observations in the Operating Room
8.4 Understanding the Different Types of Heart Valve Surgeries
8.4.1 Aortic Valve Surgery
8.4.1.1 Aortic Valve Replacement
8.4.1.2 Aortic Valve Repair
8.4.2 Mitral Valve Surgery
8.4.2.1 Mitral Valve Repair
8.4.2.2 Mitral Valve Replacement
8.4.2.3 Tricuspid and Pulmonary Valve Surgery
8.4.3 Heart Valve Surgery and Coronary Artery Disease
8.5 Once the New Heart Valve Is in Place: Final Surgical Steps
8.5.1 Cardiac Imaging
8.5.2 Completing the Surgery
8.5.3 Invasive Equipment for Safe Early Recovery
8.6 Conclusion
References
9: Transcatheter Treatment Options for Acquired Valvular Heart Disease
9.1 Introduction
9.2 Treatment of Aortic Valve Disease
9.2.1 Transcatheter Aortic Valve Replacement
9.2.1.1 Contraindications to TAVR
9.2.1.2 Evaluation and Assessment
9.2.1.3 TAVR Devices
9.2.1.4 Limitations
9.2.1.5 Evolving Applications
9.2.1.6 Procedural Approaches
9.2.1.7 Procedure
9.2.1.8 Post-Procedure
9.3 Transcatheter Mitral and Tricuspid Valve Therapies
9.3.1 Mitral Regurgitation
9.3.1.1 Evaluation
9.3.1.2 Transcatheter Mitral Valve Leaflet Repair
9.3.1.3 Transcatheter Annuloplasty Techniques
9.3.1.4 Transcatheter Chordal Repair
9.3.1.5 Transcatheter Mitral Valve Replacement (TMVR)
9.3.2 Tricuspid Regurgitation
9.3.2.1 Transcatheter Tricuspid Valve Repair
9.4 Conclusion
References
Part V: Nursing Care for Patients with Valvular Heart Disease
10: Safe Recovery after Valvular Heart Surgery
10.1 Introduction
10.2 Postsurgical Clinical Pathways
10.2.1 Enhanced Recovery after Surgery
10.2.1.1 ERAS in the Preoperative Phase
10.2.1.2 ERAS Across the Peri- and Postoperative Phase
10.3 Identification and Management of Complications Following Valve Surgery
10.3.1 Postoperative Complications
10.3.2 Pulmonary Complications
10.3.3 Cerebrovascular Incidents
10.3.4 Bleeding and Pericardial Effusion
10.3.5 Surgical Site Complications
10.3.6 Infection
10.3.7 Atrial Fibrillation and Rhythm Issues
10.3.8 Cardiac Arrest
10.3.9 Gastrointestinal Issues
10.3.10 Postoperative Central Nervous System Dysfunction
10.4 Postoperative Continued Care
10.4.1 Nursing Priorities
10.4.1.1 Management of Respiratory Status and Safe Extubation
10.4.1.2 Pain Control
10.4.1.3 Warming
10.4.1.4 Wound Care
10.4.1.5 Activity
10.4.1.6 Nutrition
10.4.2 Steps for a Safe Discharge
10.4.2.1 Discharge Planning
10.4.2.2 Site Care
10.4.2.3 Diet Considerations
10.4.2.4 Activity and Self-Care
10.4.2.5 Emotional Well-being
10.4.2.6 Medications
10.4.2.7 Cardiac Rehabilitation
10.4.2.8 Outpatient Follow-Up
10.5 Conclusion
References
11: Safe Recovery After Transcatheter Heart Valve Procedures
11.1 Introduction
11.2 Essential Elements of Care
11.2.1 Anesthesia, Sedation, and Pain Management
11.2.2 Post-Procedure Monitoring
11.2.2.1 Cardiac/Hemodynamic Status
11.2.2.2 Cardiac Rhythm
11.2.2.3 Vascular Access
11.2.2.4 Neurologic Status
11.2.2.5 Renal Function
11.2.3 Activity Progression
11.3 Time for Discharge
11.3.1 Medication Regimen
11.3.2 Endocarditis Prophylaxis
11.3.3 Diagnostic Testing
11.3.4 Activity Progression
11.4 Tools for Success
References
12: Transitions of Care and Long-Term Follow-Up after Heart Valve Procedures
12.1 Introduction
12.2 At Discharge
12.3 Follow-Up Care Immediately after Discharge
12.3.1 Usually 2–7 Days After Discharge
12.4 Early Assessment after Heart Valve Surgery and Transcather Procedures
12.4.1 Usually 4–6 Weeks Postoperatively
12.5 Long-Term Follow-Up Care
12.5.1 Usually 6 and 12 Months: Then as Recommended
12.6 The Role of Cardiac Rehabilitation
12.7 Special Consideration for Postoperative Care of VHD Patients
12.7.1 Frailty
12.7.2 Health-Related Quality of Life
References

Citation preview

Valvular Heart Disease A Guide for Cardiovascular Nurses and Allied Health Professionals Marian C. Hawkey Sandra B. Lauck Editors

123

Valvular Heart Disease

Marian C. Hawkey  •  Sandra B. Lauck Editors

Valvular Heart Disease A Guide for Cardiovascular Nurses and Allied Health Professionals

Editors Marian C. Hawkey Hackensack University Medical Center Hackensack, NJ USA

Sandra B. Lauck St. Paul’s Hospital University of British Columbia Vancouver, BC Canada

ISBN 978-3-030-86232-9    ISBN 978-3-030-86233-6 (eBook) https://doi.org/10.1007/978-3-030-86233-6 © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022 This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland

Contents

Part I Understanding Valvular Heart Disease 1 Acquired Valvular Heart Disease: Overview of Patient Population ��������������������������������������������������������������������������������������������������   3 Marian C. Hawkey and Bettina Hoejberg Kirk 2 Anatomy and Pathophysiology of Valvular Heart Disease��������������������  15 Elizabeth M. Perpetua and Dmitry B. Levin Part II Valvular Heart Disease Program Structure 3 The Heart Team: A Gold Standard of Care��������������������������������������������  59 Sandra B. Lauck and Amanda Smith 4 Processes of Care and Evaluation Pathway for Patients with Valvular Heart Disease����������������������������������������������������������������������  73 Kimberly Guibone and Jennifer Munoz Part III Assessing Valvular Heart Disease 5 Imaging Modalities in the Diagnosis and Treatment of Acquired Heart Valve Disease��������������������������������������������������������������  89 Sarah E. Clarke 6 Measuring Function, Frailty and Quality of Life in People with Heart Valve Disease�������������������������������������������������������������� 123 Astri Tafjord Frantzen, Sandra B. Lauck, and Tone M. Norekvål 7 Making a High-Quality Treatment Decision: Shared Decision-Making �������������������������������������������������������������������������� 135 Roseanne Palmer Part IV Valvular Heart Disease Treatment Options 8 Surgical Treatment for Patients with Valvular Heart Disease �������������� 151 Britt Borregaard

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Contents

  9 Transcatheter Treatment Options for Acquired Valvular Heart Disease���������������������������������������������������������������������������������������������� 167 Martina Kelly Speight Part V Nursing Care for Patients with Valvular Heart Disease 10 Safe Recovery after Valvular Heart Surgery������������������������������������������ 193 Patricia Keegan and Casey Panebianco 11 Safe Recovery After Transcatheter Heart Valve Procedures ���������������� 215 Janet Fredal Wyman 12 Transitions of Care and Long-Term Follow-Up after Heart Valve Procedures ���������������������������������������������������������������������������� 237 Nicola Straiton

Introduction

Valvular Heart Disease People with acquired valvular heart disease present with diverse, complex and challenging diseases and care requirements. The progressive haemodynamic impact of valve stenosis, regurgitation or other structural issues result in significant health challenges, including escalating symptom burden and deteriorating quality of life, worsening cardiac function and co-morbidities, hospital admissions and mortality. The care of the growing number of people living with valvular heart disease is one of the most innovative areas of cardiac clinical practice and research. The recent advancement of treatment options and technology, cardiac imaging, clinical assessments and processes of care have contributed to a highly innovative environment that continues to improve outcomes and delivery of health services to address the burden of valvular heart disease.

Experts Needed: Opportunities for Clinical Leadership The assessment and treatment of valvular heart disease require unique expertise to ensure that patients achieve the best possible outcomes, especially in the setting of this practice environment of rapidly evolving treatment options and evidence. Nurses and allied health professionals play an essential role in the screening, assessment, case management and care during valvular heart disease patients’ journey of care from referral to discharge, and in their long-term management and episodic transitions of care. The professional development of this group of health care providers has lagged behind these advances, and has not fully equipped the team with the specialized knowledge to care for this unique group of patients.

A Unique Resource for a New Field of Practice This resource aims to help close this gap. The chapters in the text offer a comprehensive review to guide cardiovascular nurses and allied health professionals to care for the diverse acquired valvular heart disease population throughout the continuum vii

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Introduction

of their complex journeys of care. Our goal is to build on the expertise of nurses and other specialized health care providers who exercise diverse roles at different points of care delivery, ranging from heart valve clinics to critical and cardiac care in-­ patient units, and contribute to developing the specialized area of valvular heart disease nursing and practice. Similar to the well-established clinical practices focused on heart failure, heart rhythm and congenital heart disease, we believe that it is time to acknowledge valvular heart disease as an important speciality within the discipline of cardiovascular nursing, and the practice of physician assistants and other allied health professionals. The text focuses on the building blocks of the specialized care of valvular heart disease. The first section establishes foundational knowledge to understand the patient population and the pathophysiological burden of aortic, mitral, tricuspid and pulmonary valve diseases. The complexity of how to provide patient-centred, innovative and efficient access to treatment is discussed in the section focused on valvular heart disease program structure. In this second section, discussions about the multidisciplinary heart team approach, processes of care and the assessment pathway provide clinicians with a road map to guide the important structural components of program development. Next, we discuss in detail the components of the assessment of valvular heart disease that present unique challenges for clinicians to gain expertise in imaging modalities, the consideration of functional status, frailty and self-reported health status, and the integration of shared decision-making to strengthen the shift to patient-centred care. The chapters outlining surgical and transcatheter approaches to the treatment of valvular heart disease outline a beginning understanding of contemporary options for valve replacement and repair. In the last section, we shift our attention to the nursing care expertise and competencies to facilitate patients’ safe recovery after treatment and their successful transition home to derive the quantity and quality of life benefit of the treatment of valvular heart disease.

A Team of International “Practice-Close” Leaders In assembling our team of co-authors, we purposefully sought the collaboration of a diverse group of contributors who hold distinct clinical and/or academic roles, have varied experience and expertise in the field of valvular heart disease, and practice in different international regions. We are particularly proud that this text is the result of the collective efforts of nurses and allied health professionals who provide direct care to patients and their families, hold “practice-close” clinical, administrative or teaching leadership roles, or pioneer nurse-led research that is advancing evidence in this field. This outstanding group is internationally recognized as some of the most innovative nursing and allied health leaders in this field and has significantly contributed to building a community of practice, teaching and scholarship to guide practice and champion their role in multidisciplinary practice. The reader will note how this intentional diversity is visible in the chapters in which regional nomenclature is left intact (e.g., transcatheter aortic valve implantation vs.

Introduction

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replacement) to recognize the differing contexts of care that enrich the field. We are thankful for the co-authors’ commitment to this project, the excellence of their contributions, and for their trust in our leadership. Valvular Heart Disease: A Guide for Cardiovascular Nurses and Allied Health Professionals is the first clinical resource that provides practical and evidence-based guidance for nurses and health care providers to strengthen their knowledge and skillset in the specialized care of the unique group of patients living with complex heart valve disease. We hope that the collective efforts of the contributing team will serve to improve patient care, support professional development, and strengthen the leadership of nurses and allied health professionals to advance this exciting and innovative field. Marian C. Hawkey Hackensack University Medical Center, Hackensack, NJ USA Sandra B. Lauck St. Paul’s Hospital, University of British Columbia, Vancouver, BC Canada

About the Contributors

Britt Borregaard, PhD  works as a Clinical Nurse and an Associate Professor at the University of Southern Denmark and the Department of Cardiology, Department of Cardiothoracic and Vascular Surgery, Odense University Denmark. Britt has clinical and research experience optimizing clinical pathways among patients undergoing conventional valve surgery. Her research focuses on patient-reported outcomes, frailty assessments and organizational perspectives. Sarah  E.  Clarke, DNP, ACNP-BC  is a Senior Principal Program Development Consultant for Medtronic. Sarah E. Clarke is a subject matter expert in clinical infrastructure for valve programs and supports transcatheter aortic valve replacement launches and programmatic efficiencies across the care continuum. Prior to joining Medtronic, she was the Nurse Practitioner and Structural Heart Coordinator for Scripps Health in La Jolla, CA, USA, and brings frontline experience in the management of structural heart disease, market and service line development, clinical operations, outreach, education, and quality initiatives. Astri Tafjord Frantzen, RN, MSc  is working as a TAVI coordinator at the Section for cardiothoracic surgery, Department of Heart Disease, Haukeland University Hospital in Bergen, Norway. Astri Frantzen is specialized as a cardiovascular nurse with 25  years of experience. Her field of research is frailty and patient-reported outcomes in patients undergoing advanced heart treatment. She holds a master’s degree in frailty in TAVI (2014) and is an active member of PROCARD (PatientReported Outcomes in CARDiology) research group. Kimberly  Guibone, DNP, ACNP-BC, FACC  is the Structural Heart Clinical Program Manager at Beth Israel Deaconess Medical Center in Boston, MA, USA, and has led the Structural Heart program there since its inception and early clinical trials. She completed her graduate work at Georgetown University, Washington DC, USA, and her doctoral studies in Nurse Executive Leadership at Simmons University in Boston, MA, USA. Her areas of interest include enhancement of the advanced practitioner role, addressing disparities in care, development of the heart team, and clinician burnout. She currently resides in NH with her husband and two nieces.

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About the Contributors

Marian C. Hawkey, RN  has an extensive nursing background in cardiac and critical care and has specialized in the field of transcatheter heart valve therapy since 2006. She is an invited speaker at national and international cardiology meetings and has co-edited and co-authored multiple publications on topics relevant to the care of patients undergoing transcatheter valve replacement. Marian C. Hawkey has collaborated on the development of national training courses for nurses and allied health professionals working in the transcatheter valve therapy field. Her areas of interest include fostering the development of valve program clinicians, engagement of the extended heart team, and structural heart program process improvement. Patricia  Keegan, DNP, NP-C, FACC  is originally from New Jersey and now resides in Atlanta, GA. She received her master’s in nursing from the University of Alabama at Birmingham and her Doctorate in Nursing Practice from the University of South Alabama. Her career started at Emory University Hospital as a bedside nurse in Cardiology. This is where she found her love of Structural Heart Disease. Patricia Keegan participated in the care of the first TAVR performed at Emory in 2007. She now serves as the Program Director for the Structural Heart Program for Emory Healthcare. She has co-authored multiple publications and has been invited to speak nationally about Structural Heart Disease. Her platforms include patient advocacy and nursing empowerment. Bettina Hoejberg Kirk, RN, MScN  is a Clinical Nurse Specialist in valvular heart diseases and structural heart diseases, following the patients’ pathways in the Department of Cardiology and Cardiac Catheterization Laboratory. She has extensive experience as a TAVI Valve Coordinator, working on optimizing the patient pathways and improving patients’ experiences and recovery. Additionally, Bettina Hoejberg Kirk focuses on the importance of clinical leadership for best practices. Sandra  B.  Lauck, PhD, RN, FCAN  holds the St. Paul’s Hospital and Heart & Stroke Foundation Professorship in Cardiovascular Nursing at the University of British Columbia (UBC), Vancouver, BC, Canada. She has a joint appointment as clinical associate professor at the UBC School of Nursing and nurse clinician scientist at the Centre for Heart Valve Innovation, St. Paul’s Hospital. Her research program focuses on the measurement of patients’ perspectives and the development of processes of care to support innovation in cardiovascular care. Dmitry  B.  Levin, BA  is the Associate Director of the Center of CardioVascular Innovation at the University of Washington in Seattle, WA, USA. As a pioneering research scientist and engineer, Levin is internationally recognized for advancing medical device development, education, and training in structural and valvular heart disease. Levin has also paved the way for the application of anatomy and physiology bioskills laboratories, 3D printing, virtual reality, and augmented reality for transcatheter structural heart therapy in pre-clinical and clinical arenas. For these domains of expertise, Levin is an invited faculty member for scientific sessions across the globe and a widely published author for peer-reviewed medical journals in cardiology.

About the Contributors

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Jennifer  Munoz, MSN, APN-C  received her Bachelor of Science Degree in Nursing from Seton Hall University and her Master’s Degree in Nursing/Adult Nurse Practitioner from Rutgers University. Her nursing background has been in Cardiology, Cardiac Surgery and now Structural and Congenital Heart. She currently is a Nurse Practitioner/Clinical Valve Coordinator of the Structural and Congenital Heart Group at Hackensack University Medical Center in Hackensack, New Jersey. Tone M. Norekvål, RN, MSC, PhD, FESC, FAHA  is a Professor in Cardiovascular Nursing at the Department of Clinical Science, University of Bergen, and Haukeland University Hospital, Bergen, Norway, where she is the chair of the Patient-Reported Outcomes in Cardiology (PROCARD) research group. She is the founder and former director of the Centre on Patient-reported Outcomes in Bergen leading national initiatives in Patient-reported Outcomes in the national medical quality registries. Tone Norekval is the principal investigator of the CARDELIR study researching delirium as primary outcome after heart valve therapy. Frailty is also a great research interest. Norekvål is actively involved in the European Society of Cardiology and is an associate editor of the European Journal of Cardiovascular Nursing. Roseanne  Palmer, MSN RN  whose career in critical care, palliative medicine, health care administration, and most recently structural heart and valvular heart disease, created a foundation and passion for shared decision-making in clinical practice. She has participated in research, published and speaks on issues related to patient-centred goals, shared decision-making, and structural heart disease. Throughout her career, she has been a dynamic advocate for patient voice. Roseanne was part of the Dartmouth Hitchcock Structural Heart Leadership team responsible for developing and implementing one of the first 25 such programs in the nation. She continues to practice at Dartmouth Hitchcock Medical Center, Lebanon, NH. Casey  Panebianco, DNP, APN-C  has been a board-certified Advanced Practice Nurse since 2004 and obtained her Doctorate in Nursing Practice in 2012. In the beginning of her career her focus was in cardiac critical care and in 2006 Casey joined the Division of Cardiothoracic Surgery at Robert Wood Johnson University Hospital in New Brunswick, New Jersey. Casey became the Lead APN of this division in 2014. During this time Casey has been involved in the development and implementation of multiple programs and safe practice protocols. Some of these include an Enhanced Recovery after Surgery (ERAS) program, Extracorporeal Membrane Oxygenation (ECMO) program, and TAVR fast-track programs. Casey is a proud mother of two beautiful daughters. Elizabeth  M.  Perpetua, DNP, ANP-BC, ACNP-BC, FACC  is a first-generation Filipina-American and board-certified Adult and Acute Care Nurse Practitioner. She completed her Master of Nursing and Doctor of Nursing Practice degrees at the University of Washington. Elizabeth Perpetua is the founder of Empath Health Services LLC and serves as a board member, advisor, consultant, and educator for health systems, cardiology societies, patient advocacy organizations, medical and life sciences industry, and startup companies. Perpetua is an Adjunct Professor of Nursing at Seattle Pacific University. She has presented and published widely on cardiac

xiv

About the Contributors

nursing and program development in structural and valvular heart disease. Her passions are innovations in systems of care delivery and the advancement and empowerment of the profession of nursing. She resides in Seattle, WA, with her two sons. Amanda  Smith, DNP  is the Nurse Practitioner and Coordinator for the Aortic Valve Program at Hamilton Health Sciences, Hamilton, ON, Canada. Amanda is originally from North Carolina and now resides in Ontario, Canada. She received her Bachelor of Science in Nursing from East Carolina University, her Master of Science in Nursing from the University of California, Los Angeles, and her Doctorate of Nursing Practice from Duke University. Amanda Smith co-leads the Canadian TAVR Community of Practice. Martina Kelly Speight, MSN, RN, FNP  is a board-certified Nurse Practitioner in the Structural Heart Program at Stanford Health Care in California. Martina established her role on the Stanford multidisciplinary heart team in 2008 where she coordinated research efforts and greatly contributed to program development. In her role as Nurse Practitioner, Martina Speight has become a clinical expert in the care and management of patients undergoing treatment for Valvular Heart Disease. She is passionate about leading efforts that improve program outcomes, efficiencies, and patient experiences. Martina has contributed to multiple publications and speaks nationally about Heart Valve Disease and Structural Heart Program development. Nicola Straiton, MSc, RN  is a nurse researcher and PhD student within the Faculty of Medicine and Health at the University of Sydney, Australia. In addition, she is a Project Manager at the Australian Clinical Trials Alliance (ACTA), the peak body supporting the investigator-led research sector across Australia. Her clinical and academic career centres on understanding and supporting cardiovascular disease patients and their families, as demonstrated in her research in which she is exploring acceptability of contemporary heart valve surgery by patients and families, and quality of life outcomes. She is interested in clinical trial methodology, patient engagement in research, and digital health. Janet Fredal Wyman, DNP, ACNS-BC, FACC  is the Administrative Director for Structural Heart Disease Clinical Services for the Henry Ford Health System; appointed in May 2019 to oversee clinical practice and outcomes as well as programmatic growth of the Structural Heart service line. She is an original member of the multidisciplinary heart team who established the Structural Heart Program in 2010 and has been intimately involved in its growth to a nationally recognized leader in innovative transcatheter therapies, having performed nearly 5000 transcatheter structural heart and multiple first in man procedures. She joined the Heart and Vascular Institute in 2000 as a cardiovascular nurse practitioner. Wyman completed her Doctorate in Nursing Practice at Wayne State University in Detroit, Michigan (2013), and her Master’s Degree in Nursing (1991). She earned her Baccalaureate in the Science of Nursing at the University of Michigan (1978). She is a Board-Certified Clinical Nurse Specialist with a focus on Adult Health and Cardiovascular diseases.

Part I Understanding Valvular Heart Disease

1

Acquired Valvular Heart Disease: Overview of Patient Population Marian C. Hawkey and Bettina Hoejberg Kirk

1.1

Objectives

1. Provide a broad overview of the population of patients with acquired valvular heart disease. 2. Identify challenges associated with the care of patients with valvular heart disease. 3. Describe key features of acquired valvular heart disease pathologies.

1.2

 hallenges Associated with the Care of Patients C with Valvular Heart Disease

Many patients with acquired valvular heart disease (VHD) present with complex clinical profiles associated with age, comorbid burden, frailty and disability, and/or multi-valve disease. These complexities necessitate a comprehensive evaluation pathway that not only considers clinical and anatomic features, but also must accommodate for patient preferences, goals, and expectations. A collaborative multidisciplinary team (MDT) provides the foundation for making balanced treatment

M. C. Hawkey (*) Hackensack University Medical Center, Hackensack, NJ, USA B. H. Kirk Rigshospitalet, Copenhagen, Denmark e-mail: [email protected]

© The Author(s), under exclusive license to Springer Nature Switzerland AG 2022 M. C. Hawkey, S. B. Lauck (eds.), Valvular Heart Disease, https://doi.org/10.1007/978-3-030-86233-6_1

3

4 Stage

M. C. Hawkey and B. H. Kirk Definition

Description

A

At risk

Patients with risk factors for development of VHD

B

Progressive

Patients with progressive VHD (mild to moderate severity and asymptomatic)

C

Asymptomatic severe

Asymptomatic patients who have the criteria for severe VHD:

C1: Asymptomatic patients with severe VHD in whom the LV or RV remains compensated C2: Asymptomatic patients with severe VHD with decompensation of the LV or RV D

Symptomatic severe

Patients who have developed symptoms as a result of VHD

LV indicates left ventricle; RV, right ventricle; and VHD, valvular heart disease.

Fig. 1.1  Stages of VHD. (Reprinted with permission from Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP 3rd, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O’Gara PT, Rigolin VH, Sundt TM 3rd, Thompson A, Toly C. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2021 Feb 2;143 (5):e35–e71. https://doi.org/10.1161/CIR.0000000000000932. Epub 2020 Dec 17. Erratum in: Circulation. 2021 Feb 2;143 (5):e228. Erratum in: Circulation. 2021 Mar 9;143 (10):e784. PMID: 33332149)

decisions. Shared-decision making is an essential component of the overall decision-­ making process for engagement of patients and their families/significant others and for adequate expression of goals of care. The AHA/ACC Guideline for the Management of Patients with Valvular Heart Disease [1] includes a framework for the staging of VHD with a range from those at risk for the development of VHD, based on comorbid conditions (Stage A), to those with severe and symptomatic VHD (Stage D). This classification of valve disease severity is based on criteria such as symptoms, valve anatomy, valve hemodynamics, ventricular and vascular function (Fig. 1.1) [1]. There are established and validated scoring algorithms which assess for surgical mortality risk such as the Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Predicted Risk of Mortality Calculator [2] (https://riskcalc.sts.org/stswebriskcalc/ calculate) and the European System for Cardiac Operative Risk Evaluation (EuroSCORE) [3] (http://www.euroscore.org/calc.html). However, these scores do not fully consider many factors which can contribute to procedural mortality risk. The impact of high comorbid burden, frailty, and disability must be factored into the treatment plan and the associated influence on goals of care. The treatment

1  Acquired Valvular Heart Disease: Overview of Patient Population Low-Risk SAVR Low-Risk Surgical Mitral Valve (Must Meet Repair for Primary MR High Surgical Risk ALL Criteria (Must Meet ALL (Any 1 Criterion in This Column) Criteria in This Column) in This Column)

Criteria

5

Prohibitive Surgical Risk (Any 1 Criterion in This Column)

STS-predicted risk of death*

50% at 1 y OR

Frailty†

None AND

None AND

≥2 Indices (moderate to severe) OR

≥2 Indices (moderate to severe) OR

Cardiac or other major organ system compromise not to be improved postoperatively‡

None AND

None AND

1 to 2 Organ systems OR

≥3 Organ systems OR

Procedure-specific impediment§

None

None

Possible procedurespecific impediment

Severe procedure-specific impediment

*Use of the STS Predicted Risk of Mortality (http://riskcalc.sts.org/stswebriskcalc/#/) to predict risk in a given institution with reasonable reliability is appropriate only if institutional outcomes are within 1 standard deviation of the STS average observed/expected mortality ratio for the procedure in question. The EUROSCORE II risk calculator may also be considered for use and is available at http://www.euroscore.org/calc.html. *Seven frailty indices: Katz Activities of Daily Living (independence in feeding, bathing, dressing, transferring, toileting, and urinary continence) plus independence in ambulation (no walking aid or assistance required, or completion of a 5-m walk in