An Evaluation of Physician and Patient Opinions with Patient Outcome Assessment to Inform Post-Procedure Driving Guidelines following Transcatheter Aortic Valve Insertion: TAVI-D (The Post-TAVI Driving Study)

Background: Surgical aortic valve replacement (SAVR) and transcatheter aortic valve insertion (TAVI) are known treatments for severe aortic stenosis. TAVI is a minimally-invasive method with shorter recovery time when compared to SAVR. In October 2023, the Canadian Cardiovascular Society (CCS) released their Fitness to Drive Guidelines and recommended a one-month post-procedure driving restriction for both SAVR and TAVI patients. Adequate post-TAVI patient clinical data was lacking to inform such a guideline. Methods: A dual-component study was created to 1) assess Canadian TAVI centre’s opinions on the one-month driving restriction and recovery post TAVI and 2) analyze TAVI patient outcomes and gather data on patient opinions and driving habits to inform an updated post-TAVI driving guideline. A 15-question survey was distributed to 31 Canadian TAVI centres in April 2024. From June 2024 to January 2025, TAVI patient recovery was clinically assessed through a short-term longitudinal prospective observational study at the Mazankowski Alberta Heart Institute (MAZ). A 17-question survey was also circulated to all enrolled post-TAVI patients (30-90 days post procedure) to examine one-month post-procedure recovery and collect opinions on the driving restriction. Results: Twenty-five (80.6%) TAVI centres participated. Twenty-nine TAVI physicians and site coordinators provided responses. 20.7% expressed that a one-month driving restriction was appropriate while most (79.3%) stated that such a guideline was ‘too long’. Recommendations for a new driving guideline for post-TAVI patients having undergone a successful, uncomplicated, transfemoral (TF) procedure were as follows: 48 hours (6.9%), 72 hours (6.9%), one week (24.1%), two weeks (41.4%), three weeks (6.9%), and one month (13.8%). Developing conduction abnormalities was the main (89.7%) listed post-TAVI driving concern. Driving guidelines >1 month were proposed for patients with transapical TAVI (67.7%), alternative arterial access TAVI (51.6%), access-site or vascular complications (48.4%), or conduction disturbances without pacemaker insertion (45.2%). One hundred and eleven TAVI patients fully participated in the observational and survey-based study. One hundred and nineteen patients originally consented to enrolment although eight were removed for meeting exclusion criteria: deceased during TAVI (n=1), deceased post TAVI (n=3), and withdrawn for other reasons (n=4). The one-month driving restriction was felt to be ‘too long’ by 52.3% of participants. Pacemaker implantation during clinical study follow-up occurred in 20 patients (n=20/111, 18%), with 65% occurring during TAVI hospitalization. All patients who experienced conduction abnormalities and underwent pacemaker implantation post TAVI reported feeling symptomatic between TAVI hospital admission and one week post except one at two weeks. Of the seven who returned to hospital for pacemaker insertion, 71.4% (n=5) of readmissions occurred within two weeks and 28.6% (n=2) >3 weeks. Only one patient without existing or post-TAVI conduction disturbances before discharge developed new RBBB and required pacemaker insertion one week after TAVI. The other 95% of pacemaker patients had known conduction disturbances or newly developed them post procedure before leaving hospital. Immediate post-procedure access-site-related complications (n=4, 3.6%) were manageable and resolved during TAVI admission. Conclusion: A one-month post-TAVI driving guideline was considered overly cautious by most Canadian TAVI centres. In conjunction with patient recovery data, considering shortening the driving restriction to <2 weeks for successful uncomplicated TF TAVI patients without pre-existing or new post-TAVI conduction abnormalities is proposed.

Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.