Older, frail adults with severe symptomatic aortic stenosis undergoing TAVR often experience highly variable recovery, complications such as delirium and heart blocks, prolonged hospital stays, and distress for patients and families. Conventional care pathways tend to emphasize procedural success rather than the full recovery episode, with limited standardization, fragmented communication, and inconsistent measurement of outcomes that matter most to patients. Our initiative, the ERAS-inspired TAVR value pathway at Cheng Hsin General Hospital, was created to improve patient value throughout the entire TAVR journey systematically. We integrate ERAS protocol with a peri‑procedural digital platform to deliver coordinated, outcome‑driven care from pre‑assessment through 30‑day follow‑up.
The pathway is tailored to an older, multimorbid, and often frail population, emphasizing early mobilization, delirium prevention, symptom management, and shared decision‑making with patients and families. The initiative is organized as an IPU, bringing together anesthesiology, cardiology, cardiac surgery, nursing, case management, physiotherapy, and cardiac rehabilitation. The team co‑designs and consistently refines standardized order sets, risk‑stratified care plans, and discharge criteria. The digital platform supports pre‑procedure education, structured frailty and risk assessments, automated prompts for mobilization and delirium screening, electronic care bundles, and systematic capture of patient‑reported outcome measures (PROMs). Patients and families are actively engaged throughout the journey; they receive tailored information on expectations, rehabilitation goals, and warning signs, and are invited to share their preferences and concerns. This empowers patients and aligns treatment pathways with what they value most, maintaining independence, cognitive function, and quality of life in their home environment. Preliminary results show reduced time to first mobilization, lower rates of delirium and early complications, shorter length of stay, and fewer early readmissions, with team satisfaction increasing through clearer roles, better communication, and a clearer link among outcomes and visible impact.
What makes this initiative unique is the tight integration and deployment within a fully formed IPU, and its explicit management as a value‑based program. By coupling standardized, evidence‑based care with real‑time data, feedback loops, and patient‑reported outcomes, the pathway creates a scalable model for high‑value structural heart care across institutions and can be extended to other cardiovascular populations.