The cardiovascular nursing role in supporting innovations in care for transcatheter aortic valve implantation: streamlining care pathways

Abstract Background Rapidly evolving technology and procedural approaches in TAVI have led to streamlined care pathways and improved patient experiences. Cardiovascular nurses play a pivotal role in developing and leading innovative models of care. Purpose To describe the cardiovascular nursing experience with development, implementation, and evaluation of an early recovery after TAVI (ERT) pathway for nurse-supported sedation integrated with a same-day discharge program at a quaternary hospital. Methods A multidisciplinary working group co-led by a Clinical Nurse Specialist and advanced cardiac nursing leaders designed a comprehensive pathway for identifying suitable patients for nurse-supported sedation TAVI in collaboration with medicine. The team developed a standardized pre-procedural screening health questionnaire, defined new intra-procedural nursing workflows, and incorporated evidence-based early mobilisation strategies. Structured patient education, shared decision-making approaches, early discharge planning and follow-up measures were included. Utilizing quality improvement methodology of Plan-Do-Study-Act cycles, we evaluated and adapted changes iteratively. Quality indicators included procedural safety, sedation-related complications, workflow efficiencies, and overall patient experience. Results A standardised process for a nurse-supported sedation TAVI coupled with a target of same-day discharge pathway was successfully implemented to support improved access to care and reduce health resource utilisation at our site. Of the 70 patients enrolled in between October 2022- March 2025, 67 (95.7%) were successfully treated with nurse-supported sedation and discharged home the same day. Mean age was 79 ± 5.6 years, 18% were female and 41.4% had a functional class New York Heart Association III/IV symptoms. All patients received minimal or no sedation and there were no sedation-related adverse events. There were no peri-procedural complications requiring escalated care. 1 patient had an emergency visit within 24 hours. Rate of successful next-day telephone follow-up was 82.9%. Additionally, the successful implementation of this initiative was facilitated by the development of the ERT nurse role- supporting catheterization lab nurses to their full scope of practice. Conclusion This initiative illustrates the essential role of the cardiovascular nurse leaders in innovating cardiac care delivery. Through advanced clinical and leadership skills, competencies in applying knowledge translation principles and a patient-centered approach to care, cardiovascular nurses are well positioned to drive system-level evidence-based improvements. This pathway demonstrates a scalable, safe, and transformative nursing-led approach that aligns with contemporary demands on TAVI care today.