Patient discussions
The American College of Cardiology/American Heart Association (ACC/AHA) recommends ensuring that patients with prosthetic valves be aware of the need for antibiotics prior to certain medical procedures (e.g., dental visits); the patient should be counseled to seek medical professional advice about the appropriateness of prophylaxis if there is any uncertainty.[26]
Patients should also be made aware that following aortic valve replacement, they still have significant valve disease. In addition, other cardiovascular comorbidities frequently exist, and thus appropriate diet and exercise regimens should be adopted.
The return of preoperative symptoms needs to be brought to the attention of a medical professional as soon as they are noted, so that appropriate evaluation can be performed.
If the patient with AS requires intervention, the National Institute for Health and Care Excellence (NICE) in the UK recommends discussing the possible benefits and risks of intervention. It is advised that the following is included in the discussion:[28]
The long and short term benefits to quality of life
Prosthetic valve durability
The risks associated with the procedures
The type of access required for surgery (median sternotomy, minimally invasive surgery, or transcatheter [for patients at high surgical risk])
The possible need for other cardiac procedures in future.
In addition, NICE recommends that patients are provided information about:[28]
The expected progression and prognosis, including the likely length of the asymptomatic stage
Any need for intervention, including the type of intervention
The possible effects of other conditions on long term outcomes
Rehabilitation and long term outcomes
Pregnancy (if appropriate)
Palliative care and how to access this (if appropriate).
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