Large Bore Vascular Access Closure Device Strategies

ABSTRACT

Background: The 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.

Methods: Patients 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.

Results: In 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.

Conclusion: The 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

KEYWORDS:

• Vascular closure device
• ProGlide
• Angio-Seal
• MANTA
• TAVR

Disclosure statement

The authors have no conflicts of interest to report.

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Funding

The authors have no funding to report.