Cardiology teams looking to increase their use of Transcatheter Aortic Valve Implantation (TAVI) for suitable patients can now access detailed pathway guidance based on best practice from colleagues at James Cook University Hospital.

Patients with severe aortic stenosis (narrowing of the aortic valve) are at high risk of death and poor quality of life if left untreated. However, some – for example, those who are frail or have other comorbidities – are unsuitable for open heart surgery for aortic valve replacement, which requires a general anaesthetic. TAVI is a less invasive procedure, usually carried out under local anaesthetic, which can improve quality of life for suitable patients.

Getting It Right First Time (GIRFT) has now worked with the successful team at James Cook University Hospital (JCUH), part of the South Tees NHS Foundation Trust, to produce a delivery guide to optimising the TAVI pathway.

JCUH has been delivering TAVI to suitable patients under the guidance of a multidisciplinary heart team since 2009. They have developed a clear understanding of patients who can benefit from TAVI and how best to manage the pathway, from referral to treatment. Currently, JCUH lists four to five cases a day and uses local anaesthesia in more than 90% of patients. This has resulted in shorter hospital stays, better recovery times and better clinical outcomes for patients.

It is hoped the GIRFT delivery guide will be used by clinicians, organisations and systems aiming to optimise TAVI pathways, learning from JCUH’s good practice points, including:

• integrating a specialist nurse as a single point of contact for patients and referring teams;
• careful patient selection and assessment using a pre-admission clinic;
• establishing an effective multidisciplinary TAVI team; and
• developing procedural documents on how to support and care for patients in the pre-operative and post-operative phases of the pathway.

The GIRFT national report for cardiology (2021) described the development of TAVI as a catalyst for the reorganisation of valve disease services and noted national variation in TAVI services, with full day lists varying from two to five cases. Recommendations to address these variations were outlined in the report.