<p class="MsoNormal"><span lang="EN-GB">Distraction with video glasses in patients undergoing mitral transcatheter edge-to-edge repair (M-TEER) may reduce sedation requirements, a new German study suggests.<o:p></o:p></span></p> <p class="MsoNormal"><span lang="EN-GB">The trial in 60 patients compared audiovisual distraction (AVD) with video glasses and headphones playing nature documentaries versus identical inactive glasses.<o:p></o:p></span></p> <p class="MsoNormal"><span lang="EN-GB">The findings were published online in <i>JACC: Advances </i>left by Elias Rawish, MD, from the University of Lübeck, the German Center for Cardiovascular Research and University Heart Center Lübeck.<o:p></o:p></span></p> <p class="MsoNormal"><span lang="EN-GB">M-TEER is an <a href="https://pubmed.ncbi.nlm.nih.gov/34453165/">established therapy</a> for patients with moderate to severe symptomatic mitral valve regurgitation at high operative risk, the researchers noted. Given this risk, the procedure is increasingly performed under conscious sedation, especially in older and frail populations where general anesthesia risks are higher. <o:p></o:p></span></p> <p class="MsoNormal"><span lang="EN-GB">Nevertheless, those undergoing M-TEER while still conscious may experience discomfort and anxiety, which could in turn increase <a href="https://eurointervention.pcronline.com/article/addressing-interventional-periprocedural-anxiety-with-virtual-reality">procedural stress</a> and complicate sedation management, they added.<o:p></o:p></span></p> <p class="MsoNormal"><span lang="EN-GB">“Innovative” nonpharmacological techniques have been adopted for anxiety and sedation management in multiple surgical disciplines, Rawish and the team wrote, noting that VR use has been associated with reduced sedation requirements without compromising procedural safety in transcatheter aortic valve replacement (<a href="https://www.sciencedirect.com/science/article/abs/pii/S1053077023009497">TAVR</a>), for example. <o:p></o:p></span></p> <p class="MsoNormal"><span lang="EN-GB">The current study set out to test AVD techniques in the world of M-TEER, where these novel methods have remained “unexplored, despite the increasing procedural volume and the growing need for patient-centered care strategies.”<o:p></o:p></span></p> <p class="MsoNormal"><span lang="EN-GB">The 60 patients undergoing M-TEER at the University Heart Center Lübeck were assigned 1:1 to AVD or sham control and management of sedation with propofol was performed according to a uniform blinded protocol using a pragmatic target of -2 to -3 on the Richmond Agitation-Sedation Scale — a medical tool used to evaluate a patient’s level of sedation or agitation.<o:p></o:p></span></p> <p class="MsoNormal"><span lang="EN-GB">At baseline, the groups were similar in age (a mean of 82.1 years ± 7.4 in control vs 83.8 years ± 4.9 in AVD), with even sex-weighting (46.7% vs 50% respectively female), similar mean body <span style="mso-spacerun: yes;"> </span>mass index (25.3 kg/m<sup>2</sup> vs 25.3 kg/ m<sup>2</sup>) and had similar mean New York Heart Association (NYHA) functional class (2.8 vs 2.7).<o:p></o:p></span></p> <p class="MsoNormal"><span lang="EN-GB">Diabetes was numerically but not statistically more common in the control arm (13.3% vs 6.7%; P = 0.67), while hypertension, coronary artery disease and chronic obstructive pulmonary disorder (COPD) rates were otherwise similar. <o:p></o:p></span></p> <p class="MsoNormal"><span lang="EN-GB">The researchers found that the mean propofol dose<span style="mso-spacerun: yes;"> </span>— the primary endpoint<span style="mso-spacerun: yes;"> </span>— was lower with AVD than with control (4.6 mg/kg/hour ± 1.6 vs 5.9 mg/kg/hour ± 1.4; P = 0.0016).<o:p></o:p></span></p> <p class="MsoNormal"><span lang="EN-GB">Secondary endpoints included norepinephrine use, anxiety and pain on numerical rating scales, overall patient satisfaction (measured by the German adaptation of the Client Satisfaction Questionnaire), and in-hospital outcomes.<o:p></o:p></span></p> <p class="MsoNormal"><span lang="EN-GB">Norepinephrine use was numerically, but not statistically, lower (0.5 ± 1.1 vs 1.7 ± 3.4 μg/kg/h; P = 0.08), though procedural duration (P = 0.3804), hemodynamic fluctuations (peak systolic blood pressure increase [SBP]: P = 0.8078; peak SBP decrease: P = 0.0742; and vasopressor dose: P = 0.0827) and hospital length of stay (P = 0.6918) were all similar. <o:p></o:p></span></p> <p class="MsoNormal"><span lang="EN-GB">The researchers found that patients across both groups reported similar levels of moderate anxiety before the M-TEER procedure as measured by patient assessments using a numerical rating scale (NRS) from 0 for no anxiety to 10 for worst imaginable anxiety/ pain (NRS 5.1 ± 1.9 in control vs NRS 5.1 ± 1.8 in AVD; P = 0.093).<o:p></o:p></span></p> <p class="MsoNormal"><span lang="EN-GB">However, AVD reduced postprocedural anxiety immediately before intervention as measured by patient assessments using a numerical rating scale from 0 for no anxiety to 10 for worst imaginable anxiety/ pain (NRS 2.5 ± 1.7 in control vs 1.1 ± 1.0 vs in AVD; P = 0.001).<o:p></o:p></span></p> <p class="MsoNormal"><span lang="EN-GB">AVD patients also reported improved satisfaction as measured by the ZUF-8 German Patient Satisfaction Questionnaire score (2.5 ± 2.8 in control vs 24.7 ± 3.0 in AVD; P = 0.005).<o:p></o:p></span></p> <p class="MsoNormal"><span lang="EN-GB">Subjective pain levels were consistently low in both groups, with no significant differences pre-or post-intervention, while safety events were comparable.<o:p></o:p></span></p> <p class="MsoNormal"><span lang="EN-GB">“AVD significantly reduces propofol requirements and improves patient comfort and satisfaction without prolonging procedures or compromising hemodynamic stability and procedural outcomes,” the researchers concluded. <o:p></o:p></span></p> <p class="MsoNormal"><span lang="EN-GB">“These data support the integration of AVD into patient-centered, minimalist M-TEER pathways and provide a strong rationale for larger, multicenter studies powered for hard clinical, cognitive, and economic endpoints.”<o:p></o:p></span></p> <p class="MsoNormal"><span lang="EN-GB">They stressed that, given the unique challenges of M-TEER, including the need for intraprocedural echocardiographic imaging and prolonged procedural stillness, enhancing patient comfort during procedures is crucial.<o:p></o:p></span></p> <p class="MsoNormal"><b><span lang="EN-GB">Sources:</span></b><span lang="EN-GB"><o:p></o:p></span></p> <p class="MsoNormal"><span lang="EN-GB">Rawish E, John M, Lemmer F, et al. Audiovisual Distraction During Mitral Transcatheter Edge-to-Edge Repair: A Sedation-Sparing Randomized Trial. <i>JACC: Adv</i> 2026; DOI: 10.1016/j.jacadv.2026.102835.<o:p></o:p></span></p> <p class="MsoNormal"><b><span lang="EN-GB">Image Credit: MQ-Illustrations – stock.adobe.com<o:p></o:p></span></b></p>