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Comparison of suture-based vascular closure devices in transfemoral transcatheter aortic valve implantation

Selected in EuroIntervention by S. Brugaletta

References

Authors

Barbanti M, Capranzano P, Ohno Y, Gulino S, Sgroi C, Immè S, Tamburino C, Cannata S, Patanè M, Di Stefano D, Todaro D, Di Simone E, Deste W, Gargiulo G, Capodanno D, Grasso C, Tamburino C.

Reference

EuroIntervention. 2015 Oct 22;11(6):690-7

Published

October 2015

Link

Read the abstract

My Comment

What is known 

The development of the transfemoral transcatheter aortic valve implantation (TAVI) technique in clinical practice has generated the need for VCD capable of accomplishing effective haemostasis after large diameter arteriotomies. Initially, open surgical access was routinely used to introduce large sheaths and catheters. Subsequently, percutaneous techniques have emerged as the new standard, resulting in a less invasive, fully percutaneous procedure. Because there are no available percutaneous devices specifically intended for large vessel closure, pre-closure with either the 10 Fr Prostar XL® or two 6 Fr ProGlide® devices (Abbott Vascular Inc., Santa Clara, CA, USA) are commonly used for this purpose. Both of them have been shown to be effective, but no studies comparing these two closure approaches have been published so far. The aim of this analysis was to compare the acute outcomes of these two strategies for percutaneous vascular closure of large arteriotomies in the setting of transfemoral TAVI. 

Major findings

  • This was a retrospective study enrolling 278 consecutive patients from January 2012 to October 2014, dichotomised according to the vascular closure device (VCD) used for common femoral artery haemostasis (Prostar vs. ProGlide).
  • 153 patients (55.1%) underwent TAVI using the Prostar, and 125 (44.9%) using two ProGlide devices.
  • All outcomes were defined according to VARC-2 criteria.
  • Vascular complications occurred in 48 patients (17.3%), being more frequent in the ProGlide group (11.8% vs. 24.0%, p=0.007).
  • Patients who had TAVI using the ProGlide were also more likely to have a higher rate of percutaneous closure device failure (4.6% vs. 12.8%, p=0.013).
  • Percutaneous peripheral intervention was performed in 13.7% and 28.0% of Prostar and ProGlide cases, respectively (p=0.003). 

My comment

A safe vascular access represents for TAVI procedure an Achille’s heel due to the fact that many centers starting TAVI program do not have enough experience with using closure devices and prefer to have an open surgical access. For this reason, it would be important for every interventional cardiologist who enters in this field to have some experience with closure devices. In this regard, the present article shows that within two different VCD, the Prostar appears superior to the two ProGlide devices, in terms of vascular complications, device failure and peripheral interventions. These findings support that Prostar device should be preferred over ProGlide at the time of TAVI learning.

Please share with the PCR community your experience with VCD and how TAVI vascular access is managed in your hospital.

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