Managing patient expectations: transcatheter aortic valve implantation

Transcatheter aortic valve implantation (TAVI) is now an established treatment for patients with severe aortic stenosis who have been deemed high risk for open heart surgery. These patients are referred to specialist centres for assessment and to determine suitability for the TAVI procedure. This constitutes a complex population of older patients who will require multiple investigations. Each patient entering the assessment process may have different expectations about the investigations and the procedure itself. There is limited evidence regarding the impact of patient expectations on patient satisfaction; however, this is an issue the nurse specialist deals with on a regular basis. As the first point of contact for the patient, the specialist nurse is in a key position to establish effective communication with patients and their caregivers, and set realistic and individual goals for them at each stage. The results of the specific TAVI investigations will dictate the pathway for the patient, and it is important to remember that not all the patients referred to the TAVI centres will be suitable for the procedure. The aim is to ensure that the patient understands that a decision will be reached that will reflect the specialist team's views as to the best interests of the individual patient. This article will discuss the management of patient expectations based on the experiences of two specialist nurses at London TAVI centres.