Care improvement by introduction of a nurse-led structured pathway in patients undergoing transcatheter aortic valve replacement: insights from a multicentre study

With the expanding use of transcatheter aortic valve replacement (TAVR), 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 real-world data remain limited.

To evaluate the impact of a nurse-led structured pathway on workflow efficiency and clinical outcomes in patients undergoing TAVR.

We conducted a multicentre observational study including consecutive patients undergoing TAVR at two high-volume Italian centres across predefined periods. Outcomes after implementation of a nurse-led structured pathway were compared with those from a preceding period. The pathway included standardized pre-procedural assessment, minimalist peri-procedural management, and protocol-driven recovery. The primary endpoint was length of stay. Secondary endpoints included intensive care utilization, procedural duration, use of invasive devices, time to mobilization, transfusion requirements, and in-hospital and mid-term safety outcomes. After 1:1 propensity score matching, 150 patients were included (75 per group). The nurse-led pathway was associated with a shorter hospital stay (median 4 vs 7 days; P < .001), reduced cardiac intensive care unit length of stay (0 vs 2 days; P < .001), and higher discharge within <72 h (36% vs 20%; P = .029). Time to mobilization was shorter (24 vs 48 h; P < .001), with less use of venous introducers (53% vs 81%; P < .001), bladder catheters (39% vs 79%; P < .001), and transfusions (3% vs 25%; P < .001). In-hospital and 6-month adverse events were low and similar.

A nurse-led structured pathway improves efficiency and resource utilization after TAVR without compromising safety, supporting its integration into contemporary practice.