Transvascular Aortic Valve Implantation

[SBURNSTEVEN]

Why are Minimally invasive Aortic valve replacement patients at higher risk for asystole postoperatively? They have their pacing wires intact up to 72 hours post op which is longer than other cardiac surgical procedures.

[Esme12, ASN, BSN, RN]

Are you a student? What semester are you?

[Rose_Queen, BSN, MSN, RN]

Think about why these patients are having TAVIs instead of traditional valve replacement via sternotomy. That may start leading you into the right direction.

[Da_Milk_of_Amnesia, MSN]

I used to care care of these PTs all the time. I'll answer the question if it's a RN, but if it's a student then i'll give you a hint. Think about the conduction pathways.

[Biffbradford]

Boy, if I ever face some time on the table, CUT ME OPEN. I want that surgeon looking and smelling with his own eyes and nose, cutting and sewing with his own talented hands. :)

[Rose_Queen, BSN, MSN, RN]

Boy, if I ever face some time on the table, CUT ME OPEN. I want that surgeon looking and smelling with his own eyes and nose, cutting and sewing with his own talented hands. :)

That's what pretty much all of us say in the CVOR where I work. However, TAVIs are reserved (at least in my facility) only for those where surgery isn't an option. If I'm ever at that point, forget the TAVI and hang the morphine drip!

[SBURNSTEVEN]

I used to care care of these PTs all the time. I'll answer the question if it's a RN, but if it's a student then i'll give you a hint. Think about the conduction pathways.

I'm an RN. I know it must be due to an abnormality in the conduction system, but where?

[chare]

I think this diagram might help.

Bundle of His

[SBURNSTEVEN]

Thanks

[Da_Milk_of_Amnesia, MSN]

From what I remember, putting that new valve in there causes swelling to some degree. The swelling interferes with the conduction impulses, which is why sometimes (once again if i remember correctly) some of these patients would come out with some way to externally pace them. Bradycardia is not uncommon in patients who are s/p TAVI. Its been a while since I've done anything with a TAVI since starting CRNA school, so i maybe slightly off in my explanation.

[ghillbert, MSN, NP]

You have many questions which could be addressed by PubMed, UptoDate, etc. It is good habit to get into doing your own research when you have clinical questions.

[stablesystole]

The newer medtronic corevalves seem to me to be more prone to causing asystole. Probably because they extend into the ventricle more and can depress onto the purkinje system more. To the OP, watch for a newly emerging left bundle branch block, that is a strong indicator that the valve is impinging upon the conduction system and is at higher risk for asystole. Bundle change should always prompt you to get a 12-lead