Care Improvement by Introduction of a Nurse-Led Structured Pathway in Patients undergoing Transcatheter Aortic Valve Replacement: Insights from a Multicenter Study

Abstract Background 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. Aims To evaluate the impact of a nurse-led structured pathway on workflow efficiency and clinical outcomes in patients undergoing TAVR. Methods and results We conducted a multicenter observational study including consecutive patients undergoing TAVR at two high-volume Italian centers 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 shorter hospital stay (median 4 vs. 7 days; p<0.001), reduced cardiac intensive care unit length of stay (0 vs. 2 days; p<0.001), and higher discharge <72 hours (36% vs. 20%; p=0.029). Time to mobilization was shorter (24 vs. 48 hours; p<0.001), with less use of venous introducers (53% vs. 81%; p<0.001), bladder catheters (39% vs. 79%; p<0.001), and transfusions (3% vs. 25%; p<0.001). In-hospital and 6-month adverse events were low and similar. Conclusion A nurse-led structured pathway improves efficiency and resource utilization after TAVR without compromising safety, supporting its integration into contemporary practice.