Large Bore Vascular Access Closure Device Strategies
Kiran Sarathy, Kush Patel, Daniel M. Jones, Mohammed Akhtar, Vikram Khanna, Chris Broyd, Mick Ozkor, Simon Kennon, Anthony Mathur, Andreas Baumbach, Michael Mullen
Abstract
BackgroundThe optimal strategy for large bore vascular closure following TAVR is a matter of contention as major bleeding and vascular complications remain a challenge. We compared three strategies for post-TAVR vascular closure in terms of safety and efficacy: a dual ProGlide-based strategy, a hybrid strategy of ProGlide and Angio-Seal, and a MANTA strategy.MethodsPatients were enrolled in one of the three strategies: two ProGlides, a single ProGlide with an 8 F Angio-Seal, or a single 18 F MANTA.ResultsIn total, 172 patients were enrolled in this study: 86 in the MANTA group, 40 in the ProGlide/Angio-Seal group, 46 in the dual ProGlide group. Hemostasis was achieved in 95% of patients. MANTA was associated with vessel occlusion in 2% of cases. The dual ProGlide group required an extra device to achieve hemostasis in 35% of cases.ConclusionThe three strategies of MANTA, dual ProGlides, or ProGlide/Angio-Seal are all effective, but there are important differences between them which mandate careful consideration by operators.Abbreviations: TAVR: Transcatheter Aortic Valve Replacement; VCD: Vascular Closure Device; CT: Computed Tomography; DSA: Digital Subtraction Angiography