Transcatheter aortic valve implantation. Motivation in high-risk patients

Introduction. Transcatheter aortic valve implantation (TAVI) has become an alternative to open valve replacement for elderly high-risk patients. What motivates these often very old patients to undergo surgery has not been systematically studied. Methods. A semi-structured interview was developed to assess the mental health and motivation of patients consenting to TAVI. Twenty-eight patients (median age 82.5 years, range 68-90 years) completed the German version of the Hospital Anxiety and Depression Scale and a semi-structured interview that included an open question and a questionnaire with a 4-point Likert scale designed to compare the role of various factors in the decision to undergo TAVI. Results. Clinically relevant preoperative anxiety was reported by 14.3% and depression by 35.7% of all patients. The following reasons for deciding to undergo TAVI were most often mentioned as answers to the open question: reduction of dyspnoea (30%), desire to go on a family vacation (13%) and desire to support other family members (11%). In the questionnaire, the highest scores (median: 4 each) were reached in the following categories: doctors' recommendation, strong will to live, desire to avoid long-term nursing care and reduction of dyspnoea. Discussion. Elderly high-risk patients have various reasons for undergoing surgery which they can dearly name. These patients utilized the psychological interview to gain additional insight into their decision regarding the surgical procedure.