Optimal vascular closure after transcatheter aortic valve implantation: managing the most frequent complication

    Authors

    Keywords

    transcatheter aortic valve implantation, hemostasis, perclose device, vascular seal

    DOI

    https://doi.org/10.15836/ccar2024.479

    Full Text

    **Introduction**: Percutaneous hemostasis after transcatheter aortic valve implantation (TAVI) involves perclose devices, vascular seal devices, hemostatic bands, or combinations of any of them. (1) We present our experiences with full percutaneous hemostasis after transfemoral TAVI achieved by two different strategies involving perclose devices. **Patients and Methods**: Patients who underwent full percutaneous transfemoral TAVI between October 2019 and September 2024 were included in the analysis. In total, 465 patients were divided in two groups: 176 patients who systematically received two perclose devices as a primary closure strategy from October 2019 to November 2022 were assigned to group 2PC, whereas the group 1PC+1VS consisted of 289 patients who systematically received one perclose device with one 8 French vascular seal from December 2022 to September 2024. Primary endpoint was a composite of 30-day major and minor vascular complications defined by VARC-3 consortium. **Results:** There were no significant differences in demographic and clinical characteristics between the groups. Primary endpoint occurred in 12 (6.8%) patients in the group2PC and in 22 (7.6%) patients in the group 1PC+1VS (RR 1.12 95% CI 0.57-2.20 for VARC-3 major or minor vascular complication). Proportion of major vascular complications was higher in the 2PC group (1.7% vs 1%), but that difference was not significant. Logistic regression showed independent association of age (RR 1.08 95% CI 1.01-1.16) and peripheral artery disease (RR 2.66 95% CI 1.26-5.61) with the primary endpoint. There were no significant differences in primary endpoint regarding closure technique in the whole cohort, and also among different TAVI devices or sizes within both groups. **Conclusions**: Hybrid vascular closure with one perclose and one 8 French vascular seal showed similar safety with relatively lower proportion of major vascular complications compared to a standard technique using two perclose devices, irrespective of TAVI platform or size. Age and peripheral artery disease were the only variables independently associated with vascular complications.

    Literature

    1. Hadžibegović I, Unić D, Jurin I, Bradić N, Starčević B, Rudež I. Percutaneous transfemoral approach and additional vascular access selection influence hospital stayandsurvival after transcatheter aortic valve implantation. Cardiol Croat. 2021;16(1-2):36. https://doi.org/10.15836/ccar2021.36
    Cardiologia Croatica
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    Optimal vascular closure after transcatheter aortic valve implantation: managing the most frequent complication

    Extended Abstract
    Issue11-12
    Published
    Pages479
    PDF via DOIhttps://doi.org/10.15836/ccar2024.479
    transcatheter aortic valve implantation
    hemostasis
    perclose device
    vascular seal

    Authors

    Irzal Hadžibegović*ORCIDDubrava University Hospital, Zagreb, Croatia
    Daniel UnićORCIDDubrava University Hospital, Zagreb, Croatia
    Tomislav ŠipićORCIDDubrava University Hospital, Zagreb, Croatia
    Nikola PavlovićORCIDDubrava University Hospital, Zagreb, Croatia
    Marin PavlovORCIDDubrava University Hospital, Zagreb, Croatia
    Petra VitlovORCIDDubrava University Hospital, Zagreb, Croatia
    Savica GjorgjievskaORCIDDubrava University Hospital, Zagreb, Croatia
    Igor RudežORCIDDubrava University Hospital, Zagreb, Croatia
    Šime ManolaORCIDDubrava University Hospital, Zagreb, Croatia
    Ivana JurinORCIDDubrava University Hospital, Zagreb, Croatia

    *Correspondence email: irzalh@gmail.com

    Full Text

    Introduction: Percutaneous hemostasis after transcatheter aortic valve implantation (TAVI) involves perclose devices, vascular seal devices, hemostatic bands, or combinations of any of them. (1) We present our experiences with full percutaneous hemostasis after transfemoral TAVI achieved by two different strategies involving perclose devices.

    Patients and Methods: Patients who underwent full percutaneous transfemoral TAVI between October 2019 and September 2024 were included in the analysis. In total, 465 patients were divided in two groups: 176 patients who systematically received two perclose devices as a primary closure strategy from October 2019 to November 2022 were assigned to group 2PC, whereas the group 1PC+1VS consisted of 289 patients who systematically received one perclose device with one 8 French vascular seal from December 2022 to September 2024. Primary endpoint was a composite of 30-day major and minor vascular complications defined by VARC-3 consortium.

    Results: There were no significant differences in demographic and clinical characteristics between the groups. Primary endpoint occurred in 12 (6.8%) patients in the group2PC and in 22 (7.6%) patients in the group 1PC+1VS (RR 1.12 95% CI 0.57-2.20 for VARC-3 major or minor vascular complication). Proportion of major vascular complications was higher in the 2PC group (1.7% vs 1%), but that difference was not significant. Logistic regression showed independent association of age (RR 1.08 95% CI 1.01-1.16) and peripheral artery disease (RR 2.66 95% CI 1.26-5.61) with the primary endpoint. There were no significant differences in primary endpoint regarding closure technique in the whole cohort, and also among different TAVI devices or sizes within both groups.

    Conclusions: Hybrid vascular closure with one perclose and one 8 French vascular seal showed similar safety with relatively lower proportion of major vascular complications compared to a standard technique using two perclose devices, irrespective of TAVI platform or size. Age and peripheral artery disease were the only variables independently associated with vascular complications.

    Literature

    1. 1.
      Hadžibegović I, Unić D, Jurin I, Bradić N, Starčević B, Rudež I. Percutaneous transfemoral approach and additional vascular access selection influence hospital stayandsurvival after transcatheter aortic valve implantation. Cardiol Croat. 2021;16(1-2):36.DOI