Enhanced recovery after surgery turnkey order set for periprocedural care of the patient undergoing transcatheter aortic valve replacement.

OBJECTIVE

Transcatheter aortic valve replacement is now a leading treatment for severe symptomatic aortic stenosis across the risk spectrum. The choice between transcatheter and surgical aortic valve replacement remains a shared decision, particularly for patients aged 65 to 80 years. Despite extensive device-level randomized evidence and procedural standardization, periprocedural care pathways remain variable across programs. This turnkey order set integrates contemporary guidelines and consensus documents into a practical order set for the periprocedural care of patients undergoing transcatheter aortic valve replacement.

METHODS

Subject matter experts translated existing peer-reviewed society guidelines, expert consensus documents, and randomized trial evidence, identified through a structured PICO-framed (population, intervention, comparator, outcome) literature review, into a sample turnkey order set. Orders derived from consistent Class I or IIa (or equivalent) recommendations across referenced documents appear in the order set in bold type. Orders that were inconsistently Class I or IIa, Class IIb, or supported by peer-reviewed evidence appear in italic type.

RESULTS

Preprocedural care centers on interdisciplinary Heart Team evaluation, frailty and cognition assessment, baseline conduction risk stratification, anemia and iron deficiency screening, structured antithrombotic and endocrine medication management, and weight-based antibiotic prophylaxis. Intraprocedural care prioritizes ultrasound-guided femoral access, procedural sedation when feasible, normothermia, contrast minimization, and balanced procedural anticoagulation. Postprocedural care emphasizes telemetry-guided conduction monitoring, single antiplatelet therapy in patients without an indication for oral anticoagulation, oral anticoagulation alone in those with an existing indication, and early mobilization. Standardized discharge criteria target next-day discharge in appropriately selected transfemoral patients.

CONCLUSIONS

Comprehensive periprocedural pathways for transcatheter aortic valve replacement have been demonstrated to shorten length of stay without compromising safety. This turnkey order set translates contemporary guideline recommendations into actionable orders to facilitate standardized adoption of best practices across programs. The composite pathway has not been prospectively validated.