Audiovisual Distraction During Mitral Transcatheter Edge-to-Edge Repair: A Sedation-Sparing Randomized Trial

Conscious sedation is increasingly used for mitral transcatheter edge-to-edge repair (M-TEER), but balancing patient comfort with sedative-related hemodynamic and neurocognitive risk remains challenging in frail older adults.

We investigated whether audiovisual distraction (AVD) with video glasses reduces propofol requirements and improves patient experience during M-TEER performed under conscious sedation.

In this prospective randomized controlled trial, 60 patients undergoing M-TEER were assigned 1:1 to AVD (video glasses with nature documentaries and headphones) or sham control (identical inactive device). Propofol-based sedation was managed according to a uniform blinded protocol using a pragmatic Richmond Agitation-Sedation Scale target of -2 to -3. The primary endpoint was the mean propofol dose (mg/kg/h). 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.

The mean propofol dose was lower with AVD than control (4.6 ± 1.6 vs 5.9 ± 1.4 mg/kg/h; P = 0.002). Norepinephrine use was numerically lower (0.5 ± 1.1 vs 1.7 ± 3.4 μg/kg/h; P = 0.08). Procedural duration, hemodynamic fluctuations, and hospital length of stay were similar. AVD reduced postprocedural anxiety (1.1 ± 1.0 vs 2.5 ± 1.7; P = 0.001) and improved satisfaction (24.7 ± 3.0 vs 22.5 ± 2.8; P = 0.005). Safety events, including bleeding, pneumonia, conversion to general anesthesia, and clinically documented delirium, were comparable.

AVD with video glasses is a safe, pragmatic adjunct to conscious sedation in M-TEER that reduces propofol requirements and improves patient-reported comfort and satisfaction without compromising procedural efficiency or in-hospital safety. (Does audiovisual distraction reduce the need for analgesic sedation and increase patient satisfaction in patients undergoing mitral valve clipping? A randomized controlled trial; DRKS00037370).