Review of Transcatheter Aortic Valve Insertion (TAVI) Clinician Opinions on the Canadian Cardiovascular Society Post-TAVI Driving Guidelines

Background

As compared to surgical aortic valve replacement, transcatheter aortic valve insertion (TAVI) has a lower perioperative risk and an abbreviated recovery. In the absence of robust clinical data to guide decision-making, the Canadian Cardiovascular Society has now recommended the same 1-month driving restriction for both procedures.

Methods

In April 2024, a 15-question survey was circulated to all 31 Canadian TAVI centres to explore opinions on the current driving recommendations and the safety of driving post TAVI, with the goal of informing updated expert-informed guidelines.

Results

Of 31 TAVI centres, 29 individuals from 25 centres (80.6%) provided responses. The majority (79.3%) expressed that a 1-month driving prohibition was “too long,” and 20.7% stated that this restriction was appropriate. When asked to suggest a new post-TAVI driving recommendation for successful, uncomplicated, transfemoral TAVI patients, 41.4% proposed that patients be prohibited from driving for 2 weeks, 24.1% suggested 1 week, 13.8% were supportive of 1 month, and 6.9% were supportive of either 3 weeks, 72 hours, or 48 hours. The predominant driving-related concern was the development of conduction abnormalities (89.7%). A longer driving prohibition (≥ 1 month) was suggested in cases of alternative-access TAVI (transapical: 67.7%; alternative arterial: 51.6%), access-site and/or vascular complications (48.4%), and conduction abnormalities without a pacemaker (45.2%).

Conclusions

The majority of Canadian TAVI programs expressed that a 1-month driving restriction period was overly cautious and that shorter restriction periods would be more appropriate. Ultimately, before any change to post-TAVI driving restrictions may be considered, a clinical assessment of patient recovery post TAVI is needed.