An Analysis of Patient Recovery and Opinions on Driving Post-Transcatheter Aortic Valve Insertion (TAVI): the TAVI-D Study.

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.