State-of-the-art Structural Interventions in Heart Failure

Efficacy of comprehensive nursing intervention on nursing outcomes and prognostic quality of life in elderly patients with chronic heart failure

Objective

To explore the effect of comprehensive nursing intervention on nursing outcomes, self-efficacy, and quality of life in elderly patients with chronic heart failure (CHF).

Method

A retrospective analysis was conducted on the clinical data from 120 elderly patients with CHF admitted to Baoding No.1 Central Hospital from June 2019 to June 2022. Patients were divided into a control group and an observation group based on different nursing methods (n= 60 each group). The clinical data of the two groups were analyzed, comparing changes in heart function, psychological status, and quality of life before and after intervention.

Results

After intervention, both groups exhibited decreased scores on the Hamilton Anxiety Scale and the Hamilton Depression Rating Scale compared to the pre-intervention levels, with the observation group showing a significantly lower degree of decline compared to the control group during the same period (P<0.05, respectively). The overall compliance rate of medical adherence in the observation group was 85.00%, significantly higher than the 70.00% in the control group (P<0.05). After intervention, both groups exhibited improvement in left ventricular ejection fraction, left ventricular end-systolic diameter, and left ventricular end-diastolic diameter compared to the pre-intervention levels, with the observation group showing a more significant improvement than the control group (P < 0.05, respectively).

Conclusion

For elderly patients with CHF, comprehensive nursing intervention may reduce negative emotions, improve sleep quality, self-care ability, and self-efficacy, and enhance patient compliance, quality of life, and heart function.

Multimodality Imaging in Valvular Structural Interventions

Structural valvular interventions have skyrocketed in the past decade with new devices becoming available and indications for patients who would previously have been deemed inoperable. Furthermore, while echocardiography is the main imaging tool and the first line for patient screening, cardiac magnetic resonance and CT are now essential tools in pre-planning and post-procedural follow-up. This review aims to address imaging modalities and their scope in aortic, mitral and tricuspid structural valvular interventions, including multimodality imaging. Pulmonary valve procedures, which are mostly carried out in patients with congenital problems, are discussed. This article presents a guide on individualised imaging approcahes on each of the available interventional procedures.

The management of paravalvular leaks post aortic valve replacement

BACKGROUND

Paravalvular leak (PVL) is uncommon but can lead to severe complications after surgical or transcatheter aortic valve implantation. Conditions associated with PVLs such as heart failure, hemolysis, and infective endocarditis can lead to catastrophic results if not treated promptly; the therapeutic goals differ according to the presentation. It is vital that PVLs are diagnosed early using various imaging modalities. Different approaches have been studied in managing PVLs; there is an increased interest in the transcatheter aortic valve closure procedure as it is minimally invasive and decreases the occurrence of further reinterventions.

AIM

To discuss the classification of PVLs, diagnostic approaches, and available management options.

METHOD

A literature review was performed using 28 studies.

RESULTS

This review evaluated the relationship between the time of diagnosis, management of PVL and the resulting outcomes.

DISCUSSION

Patients with PVL should be assessed through a multidisciplinary team approach and a patient-selective plan should be in place.

CONCLUSION

Open surgical intervention is reserved for complex cases where minimally invasive techniques cannot be utilized.

Structural Heart Disease Emergencies

Structural heart disease (SHD) emergencies include acute deterioration of a stable lesion or development of a new critical lesion. Structural heart disease emergencies can produce heart failure and cardiogenic shock despite preserved systolic function that may not respond to standard medical therapy and typically necessitate surgical or percutaneous intervention. Comprehensive Doppler echocardiography is the initial diagnostic modality of choice to determine the cause and severity of the underlying SHD lesion. Patients with chronic SHD lesions which deteriorate due to intercurrent illness (eg, infection or arrhythmia) may not require urgent intervention, whereas patients with an acute SHD lesion often require definitive therapy. Medical stabilization prior to definitive intervention differs substantially between stenotic lesions (aortic stenosis, mitral stenosis, left ventricular outflow tract obstruction) and regurgitant lesions (aortic regurgitation, mitral regurgitation, ventricular septal defect). Patients with regurgitant lesions typically require aggressive afterload reduction and inotropic support, whereas patients with stenotic lesions may paradoxically require β-blockade and vasoconstrictors. Emergent cardiac surgery for patients with decompensated heart failure or cardiogenic shock carries a substantial mortality risk but may be necessary for patients who are not eligible for catheter-based percutaneous SHD intervention. This review explores initial medical stabilization and subsequent definitive therapy for patients with SHD emergencies.