Medical Student Cumming School of Medicine, University of Calgary Calgary, Alberta, Canada
Background: Transcatheter aortic valve insertion (TAVI) is heralded for being minimally invasive and having shorter recovery when compared to surgical aortic valve replacement (SAVR). In 2023, the Canadian Cardiovascular Society (CCS) published guidelines recommending a one-month driving restriction for TAVI and SAVR due to the risk of post-procedure conduction abnormalities and late-onset sudden cardiac death or incapacitation on the road, wanting to ensure a risk of harm < 1%. A 2024 Canadian physician survey study showed overwhelming support for a shorter driving restriction after TAVI.
METHODS AND RESULTS: Between June 2024 and January 2025, post-TAVI patients (30-90 days post-procedure) at the Mazankowski Alberta Heart Institute were enrolled in an observational study to assess recovery. A 17-question survey examined symptoms, clinical events and opinions on driving.
Of 111 participants, 96.4% received transfemoral (TF) TAVI without significant peri-procedural complications. Of patients requiring pacemaker insertion (n=20), 95% were symptomatic within one week of their procedure (one at two weeks). 65% were implanted during TAVI admission. Of post-discharge pacemaker insertions, 71.4% (n=5) were within two weeks and 28.6% (n=2) after three weeks. 90% had preexisting conduction system disease (LBBB – 1; RBBB - 9) or developed new conduction abnormalities before discharge (LBBB – 8).
Based on the risk of harm formula (fractional driving time – 4% x likelihood of cardiac incapacitation (pacemaker requirement after discharge – 7/111 (6.3%); unforeseen pacemaker-requiring conduction abnormality – 2/111 (1.8%) [both implanted ≤1 week post TAVI]) x vehicle type (private vehicle – 0.28) x risk of event resulting in injury/fatality – 2%), the on-the-road risk of harm is 0.0014% among those requiring pacemaker insertion after TAVI discharge and 0.0004% among those without conduction abnormalities.
In the patient survey, 52.3% expressed that a one-month driving restriction was ‘too long’. Although most patients had family support to provide driving assistance, a month-long driving restriction carried additional limitations: feeling a loss of freedom, less confidence in recovery and returning to normal activity, feeling like a burden to others, and the nuisance of additional logistical planning.
Conclusion: Following TAVI, the risk to population while driving is low in patients requiring pacemaker insertion after TAVI discharge (0.0014%) and very low in those without documented conduction abnormalities (0.0004%), well below the established 1% CCS threshold. This would support changes to current TAVI driving guidelines. For patients with successful uncomplicated TF TAVI, a brief restriction (48 hours) could be applied. Conservatively, two weeks could be considered for patients with conduction abnormalities.
