A nurse-led structured pathway following transcatheter aortic valve implantation: the PATH-TAVI study
D D'amario, L Cumitini, P Zumbo, G Annibali, V Galiffa, R Rosso, M Mennuni, G Musumeci, G PattiAbstract
Background
With the expanding use of transcatheter aortic valve implantation (TAVI), optimizing peri-procedural pathways to improve efficiency while maintaining safety is a clinical priority. Nurse-led structured pathways may standardize care and reduce resource utilization, but multicenter real-world data are limited. We evaluated the impact of a nurse-led structured pathway on workflow and outcomes in patients undergoing TAVI.
Methods
We conducted a multicenter observational study including consecutive TAVI patients at two high-volume Italian centers from January 2023 to December 2024. Outcomes after implementation of a nurse-led structured pathway were compared with those from the preceding period. The pathway included standardized pre-procedural assessment, minimalist peri-procedural management, and protocol-driven post-procedural recovery. The primary endpoint was hospital length of stay. Secondary endpoints included critical care utilization, procedural duration, use of invasive devices, time to mobilisation, transfusion requirements, and in-hospital and mid-term safety outcomes.
Results
A total of 202 patients were included (127 nurse-led pathway vs. 75 pre-pathway). Baseline characteristics were comparable. The nurse-led pathway reduced procedural duration (93 vs. 125 minutes, p<0.001), use of venous introducers and bladder catheters, transfusions, and enabled earlier mobilisation. Critical care stay and hospital length of stay were shorter (4 vs. 7 days, p<0.001), with more patients discharged within 72 hours (43% vs. 20%, p=0.001). In-hospital and six-month adverse events were low and similar between groups.
Conclusions
A nurse-led structured pathway significantly improves efficiency and resource utilization after TAVI without compromising safety, supporting its integration into contemporary TAVI programs.