CJC open · 2025
An Analysis of Patient Recovery and Opinions on Driving Post-Transcatheter Aortic Valve Insertion (TAVI): the TAVI-D Study.
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Jarvis Catherine R, Gouda Pishoy, Ezekowitz Justin, Smith Holly, Tyrrell Benjamin, Welsh Robert C
Аннотация
BACKGROUND: Transcatheter aortic valve insertion (TAVI) is heralded for being minimally invasive and requiring shorter recovery, compared to surgical aortic valve replacement. In 2023, the Canadian Cardiovascular Society published guidelines recommending a 1-month driving (noncommercial drivers) restriction for both procedures. A 2024 Canadian physician survey study showed overwhelming support for a shorter TAVI guideline.
METHODS: An observational prospective assessment of TAVI patient recovery was conducted from June 2024 to January 2025 at the Mazankowski Alberta Heart Institute. Post-TAVI patients were followed clinically and completed a 17-question survey examining symptoms, clinical events, and opinions on driving.
RESULTS: Of 111 participants, 96.4% received transfemoral (TF) TAVI. Of patients requiring pacemaker insertion (n = 20), 95% were symptomatic within 1 week of their procedure (1 was symptomatic at 2 weeks). A total of 65% of pacemaker-requiring patients (n = 13 of 20) were implanted during TAVI admission. Readmission for pacemaker insertion (n = 7) occurred in 71.4% (n = 5) within 2 weeks and 28.6% (n = 2) after 3 weeks, a calculated population on-the-road risk of harm of 0.0014%. A total of 90% of pacemaker patients had pre- and/or post-TAVI conduction abnormalities. Two patients developed atrial fibrillation and new right bundle branch block requiring pacemaker insertion at, respectively, 4 and 7 days post-TAVI-a 0.0004% risk. A total of 52.3% expressed that a 1-month driving restriction was "too long."
CONCLUSIONS: With calculated population on-the-road risks of harm well below the established Canadian Cardiovascular Society threshold of 0.005% (1 of 20,000), we propose shortening noncommercial driving restrictions, to 48 hours for patients with successful uncomplicated transfemoral TAVI without conduction disturbances, and to 2 weeks for those with asymptomatic conduction abnormalities who do not receive a pacemaker.
METHODS: An observational prospective assessment of TAVI patient recovery was conducted from June 2024 to January 2025 at the Mazankowski Alberta Heart Institute. Post-TAVI patients were followed clinically and completed a 17-question survey examining symptoms, clinical events, and opinions on driving.
RESULTS: Of 111 participants, 96.4% received transfemoral (TF) TAVI. Of patients requiring pacemaker insertion (n = 20), 95% were symptomatic within 1 week of their procedure (1 was symptomatic at 2 weeks). A total of 65% of pacemaker-requiring patients (n = 13 of 20) were implanted during TAVI admission. Readmission for pacemaker insertion (n = 7) occurred in 71.4% (n = 5) within 2 weeks and 28.6% (n = 2) after 3 weeks, a calculated population on-the-road risk of harm of 0.0014%. A total of 90% of pacemaker patients had pre- and/or post-TAVI conduction abnormalities. Two patients developed atrial fibrillation and new right bundle branch block requiring pacemaker insertion at, respectively, 4 and 7 days post-TAVI-a 0.0004% risk. A total of 52.3% expressed that a 1-month driving restriction was "too long."
CONCLUSIONS: With calculated population on-the-road risks of harm well below the established Canadian Cardiovascular Society threshold of 0.005% (1 of 20,000), we propose shortening noncommercial driving restrictions, to 48 hours for patients with successful uncomplicated transfemoral TAVI without conduction disturbances, and to 2 weeks for those with asymptomatic conduction abnormalities who do not receive a pacemaker.