COMBINED STRATEGY FOR LARGE-BORE ARTERIOTOMY CLOSURE AFTER TRANSCATHETER AORTIC VALVE IMPLANTATION

Backround: The vascular complications remain a relevant following transcatheter aortic valve implantation (TAVI). They are frequently associated with vascular closure device failure (VCD). Their incidence depends on different factors with reported rate between 4-19%. Vascular complications affect morbidity and mortality. The most commonly used VCDs include the suture-based ProGlide and the plug-based MANTA. The MANTA device was not superior to the use of 2 ProGlides in their direct comparison in terms of access site–related vascular complications. The alternative but less frequently used strategy is intentional combination of one suture-based VCD – ProGlide with small-bore plug-based VCD AngioSeal. The data supporting this approach are very limited, but showing lower rate of additional endovascular interventions when compared with vascular closure using two suture-based VCDs.

Methods: Retrospectively analysed comparison of two strategies: use of two suture-based ProGlides (SB group) vs. intentional combination of one ProGlide with plug-based AngioSeal 8F (CB group). The primary endpoint was occurrence of access site–related vascular complications at 30-days.

Results: We compared 71 consecutive patients treated between Aug/2020 and May/2021 with 95 consecutive patients treated between May/2021 and Apr/2022. There wasn't significant difference in patient's characteristics (SB vs. CB group): mean age 81 vs.79 years, females 54,9% vs.52%, STS score 3,47% vs. 3,46%, oral anticoagulation 38,6% vs.40,1%. Lower rate of vascular complication was observed in CB group 3,1% vs. 7,1%.

Conclusion: The combination of one suture-based VCD with one plug-based VCD is effective and safe. This strategy was associated with lower rate of vascular complication compare the use of 2 suture-based VCDs in our patient’s cohort following TAVI.