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Double closure technique during TAVR safe, feasible
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During elective transcatheter aortic valve replacement, use of a double Prostar XL suture-based closure technique yielded less bleeding and fewer complications and technical failures compared with a conventional single technique.
“Vascular complications continue to pose a challenge to the success of [TAVR] as large caliber arterial access is still required. … Percutaneous femoral artery ‘preclosure’ with the Prostar XL device (Abbott Vascular) results in a high rate of technical success, but is associated with device failure and bleeding complications in a proportion of patients. … The systematic use of two Prostar XL [vascular closure devices] in the setting of [TAVR] has not been described or evaluated,” researchers wrote in Catheterization and Cardiovascular Interventions.
The prospective, observational study included 126 patients who underwent elective TAVR via the femoral artery (18F sheath) from 2012 to 2014 (mean age, 83 years; 48% women; mean logistic EuroSCORE, 24). A single Prostar XL device closure technique was utilized in 63 patients and a double Prostar XL closure technique was used in the other 63 patients.
Technical success — hemostasis not requiring interventional or surgical repair during admission — was 98% with the double closure technique vs. 86% with the single closure technique (P = .017). The rate of a composite of VARC-2 vascular complications was 16% with the single closure technique vs. 5% with the double closure technique (P = .04) and a composite of VARC-2 bleeding complications was 27% vs. 10%, respectively (P = .004).
“This study is, to the best of our knowledge, the first description of a systematic cohort using a double Prostar XL preclosure technique in the setting of femoral [TAVR] access. … The high technical success and reduced complication rate associated with this device, particularly in a group of patients at high risk of vascular complications is notable,” the researchers concluded. – by Rob Volansky
Disclosure: The researchers report no relevant financial disclosures.
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