Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
Int J Cardiol. 2023 Sep 15;387:131130. doi: 10.1016/j.ijcard.2023.131130. Epub 2023 Jun 22.
A minimal approach, using local anaesthesia alone, has been advocated to promote faster transcatheter 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.
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 background 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 ± 13.4 vs. 38.5 ± 19.2, p = 0.02) and the perceived duration of the procedure (60.1 ± 32.3 vs. 73.0 ± 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 associated 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.
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.
提倡采用局部麻醉的最小化方法来促进中危患者更快地进行经导管主动脉瓣置换术（TAVR）。术前和围手术期的焦虑和疼痛仍然是一个关注点。虚拟现实（VR）是一种非药物分散注意力的形式，可能能够调节疼痛和焦虑。这项随机研究探索了在不镇静的情况下，VR 是否可以减轻 TAVR 期间的疼痛和焦虑，并比较了 VR 与标准护理的效果。
在 2022 年 6 月至 2023 年 3 月期间，共有 207 名患者接受了经股动脉 TAVR（TF-TAVR）。其中，117 名（56.5%）患者愿意参与研究，并符合评估的教育背景和精神状态标准。59 名患者接受了 TF-TAVR 与 VR 眼镜（VR 组）。58 名患者接受了标准 TF-TAVR 无 VR（对照组；CG）。术后焦虑评分（STAI-S）（31.5±13.4 与 38.5±19.2，p=0.02）和手术过程感知时间（60.1±32.3 与 73.0±32.4，p=0.04）在 VR 组中较低。两组之间的手术时间、疼痛和焦虑评分（视觉模拟评分）相似。并发症发生率低，与 VR 无关。术后谵妄发生在 9 名患者中，两组之间相似（VR：4[6.8%]与 CG：5[8.6%]，p=0.71）。未观察到围手术期中风。
VR 用于 TAVR 是可行且安全的，并为采用最小化方法进行 TAVR 的患者提供了焦虑和疼痛的非药物治疗谱。
