Virtual reality-assisted distraction during transcatheter aortic valve implantation under local anaesthesia: A randomised study

Background: A minimal approach, using local anaesthesia alone, has been advocated to promote faster trans-catheter aortic valve replacement (TAVR) procedures in intermediate-risk patients. Pre-and periprocedural anxiety and pain remain a concern. Virtual reality (VR) is a form of non-pharmacological distraction that can potentially modulate pain and anxiety. This randomised study explored whether VR reduces pain and anxiety during TAVR without sedation and compared the effects of VR with those of standard care. Methods and results: Between June 2022 and March 2023, 207 patients underwent transfemoral TAVR (TF-TAVR). Of these, 117 (56.5%) patients were willing to participate in the study and met the educational back-ground and mental status criteria for assessment. Fifty-nine patients underwent TF-TAVR with VR glasses (VR group). Fifty-eight patients underwent standard TF-TAVR without VR (control group; CG). Post-interventional anxiety scores (STAI-S) (31.5 & PLUSMN; 13.4 vs. 38.5 & PLUSMN; 19.2, p = 0.02) and the perceived duration of the procedure (60.1 & PLUSMN; 32.3 vs. 73.0 & PLUSMN; 32.4, p = 0.04) were lower in the VR than in the CG. Procedure time, pain, and anxiety scores (visual analogue scale) were similar between the groups. The complication rate was low and not asso-ciated with VR. Post-interventional delirium occurred in nine patients, and was similar between the groups (VR: 4 [6.8%] vs. CG: 5 [8.6%], p = 0.71). No periprocedural strokes were observed. Conclusion: VR for TAVR is feasible and safe and expands the non-drug spectrum of therapy for anxiety and pain in patients undergoing TAVR with a minimalistic approach.