DOUBLE-CHOICE: Anesthesia strategies and self-expanding valve types for TAVI

Fresh from his DOUBLE-CHOICE trial presentation at ESC Congress 2025 in Madrid, Mohamed Abdel-Wahab joins Yohei Ohno to discuss the key takeaways.

This two-by-two factorial randomised trial in patients undergoing TAVI compared a minimalist strategy using only local anesthesia with the standard of care, as well as two self-expanding valves: Evolut and ACURATE neo2. 

Results showed that the minimalist anesthesia approach was non-inferior to the conventional strategy, while the ACURATE neo2 valve also proved non-inferior to Evolut and demonstrated lower pacemaker implantation rates. This marks the first trial to establish non-inferiority of the ACURATE platform compared with a contemporary self-expanding device. 
Even though ACURATE neo2 has since been withdrawn, the findings remain highly relevant, shaping the conversation on how TAVI will evolve.