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)
Bibliographic record
Abstract
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.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.012 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".