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Jennifer Dollery RN, BSNStructural Heart Disease Program Manager

The Ohio State University Wexner Medical Center

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The Structural Heart Disease Patient Experience

Who is our TAVR population?Early TAVR ExperienceElderly PatientsMultiple ComorbiditiesHigh Risk or Prohibitive Risk for Surgery Investigational Devices

Present TAVR ExperienceYounger Patients as well as ElderlyLess ComorbiditiesLow Risk to Prohibitive RiskMix Commercially Approved Devices & Investigational Devices

Evolution of Structural Heart Procedures Peri-Valvular Leak ClosureASD & VSD ClosuresMitraClip Procedure

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Our patient experience begins with YOU!

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Referring Physician is an Integral Part of our Team & The Patient Experience

Foundational Relationship of TrustProvide Initial Insight into OSU ExperienceProvide Initial Education on Possible Procedure &

evaluation process

Referral to OSUWMC SHD

Program

Patients are referred to our office and contacted by the SHD office to discuss their appointment with our multidisciplinary structural heart disease team and any additional testing they will have that day.

Our patients will have multiple tests prior to their actual procedure. Most testing can be completed at their local facility of choice to make the process easier for patients and families.

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Referral Line

614-366-0586

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New Patient Packet • A new Patient Packet is mailed

to every patient and includes:

1. SHD office contact information and patient appointment letter

2. Health history & medications form

3. Kansas City Cardiomyopathy Questionnaire

4. Reference material supporting the Aortic/Mitral procedure and testing

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Pre-Operative Testing for Structural Heart

Procedures

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Appointment Day #1

The first day we meet your patient is typically the beginning of a year (or longer) relationship with our team.

During The First Visit• Collection of History Forms & QOL Questionnaire• Evaluate Symptoms & Disease Progression

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Appointment Day #1 cont.

• Detailed Education is Provided to Patient & Family‒ “What is aortic stenosis/mitral regurgitation?”‒ Procedure Explanation

• Pre-Operative Testing Reviewed

• Frailty Testing Performed‒ KCCQ‒ Katz Daily Living‒ Mini-Mental Exam‒ Hand Grip‒ 15m Walk/6 min Walk

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Appointment Day #1 cont.

• Physician Evaluation‒ Cardiac Surgeon‒ Interventional Cardiologist

• Consent Signed• Patient Photographed• Next Steps

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Appointment Day #2 (if indicated)

• 2nd Surgical Evaluation‒ The FDA and NCDR require the all patients that are evaluated for the

TAVR procedure see 2 surgeons face to face and they agree that the patient is low, intermediate, high or prohibitive risk for open heart surgery.

‒ 2nd surgical Evaluation can be done at OSU or Locally by a Cardiac Surgeon

• Completion of Remaining Diagnostic Testing

• Laboratory Testing‒ Type & Cross Match

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Structural Heart Committee Meeting

• All Diagnostic Testing Reviewed

• Procedural Planning

• Discuss Additional Medical Issues or Evaluation Needed‒ Hematologic Issues‒ Oncologic Issues‒ Neurologic Issues

• Schedule Patient & Mail Procedure Letter

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Procedure Day

Patients arrive 2-3 hours prior to the scheduled procedure time.

Procedures can last anywhere from 1 hour to 4 hours depending on the structural procedure being performed.

All TAVR patients recover in the PACU and lay flat for 4 hours post procedure.

Patients are then moved to the Ross Heart Hospital where they stay until discharge.

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All patients scheduled for aortic or mitral procedures

arrive the day of procedure.

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Post Procedure

Post procedure we immediately begin the preparing our patients for discharge.

They are expected to be up in the chair for all meals.

They walk 3-4 times per day.

A Gerontology referral is placed on all SHD patients post procedure for evaluation & support.

Patients are discharged home as much as possible to stay with family or have HHC.

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Length of stay varies per patient. Average length of

stay is 2.5 days in the hospital.

Post Discharge

When patients are discharged we encourage all of them to follow up with their local cardiologist and PCP within 2 weeks of discharge.

We see them back in our office at 30 days and 1 year. They complete an EKG, lab work, echocardiogram and the KCCQ questionnaire at each visit.

After that 1 year appointment we no longer need to see them unless they are in a research trial or need continued support.

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Commercially treated patients are seen at 30 days

and 1 year for follow up.

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Our Structural Heart Team thanks YOU for your continued support.

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go.osu.edu/structuralheart