Suture-mediated arterial access site closure after transfemoral aortic valve implantation

Authors

  • Philipp Kahlert MD,

    Corresponding author
    • Department of Cardiology, West-German Heart Center Essen, University Hospital Essen, University Duisburg-Essen, Germany
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  • Fadi Al-Rashid MD,

    1. Department of Cardiology, West-German Heart Center Essen, University Hospital Essen, University Duisburg-Essen, Germany
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  • Björn Plicht MD,

    1. Department of Cardiology, West-German Heart Center Essen, University Hospital Essen, University Duisburg-Essen, Germany
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  • Thomas Konorza MD,

    1. Department of Cardiology, West-German Heart Center Essen, University Hospital Essen, University Duisburg-Essen, Germany
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  • Till Neumann MD,

    1. Department of Cardiology, West-German Heart Center Essen, University Hospital Essen, University Duisburg-Essen, Germany
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  • Matthias Thielmann MD, FAHA,

    1. Department of Thoracic and Cardiovascular Surgery, West-German Heart Center Essen, University Hospital Essen, University Duisburg-Essen, Germany
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  • Daniel Wendt MD,

    1. Department of Thoracic and Cardiovascular Surgery, West-German Heart Center Essen, University Hospital Essen, University Duisburg-Essen, Germany
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  • Raimund Erbel MD, FESC, FAHA, FACC, FASE,

    1. Department of Cardiology, West-German Heart Center Essen, University Hospital Essen, University Duisburg-Essen, Germany
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  • Holger Eggebrecht MD, FESC, FACC

    1. Department of Cardiology, West-German Heart Center Essen, University Hospital Essen, University Duisburg-Essen, Germany
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  • Conflict of interest: Philipp Kahlert is a clinical proctor for Edwards Lifesciences Inc. and has received travel support from Medtronic Inc. Matthias Thielmann is a clinical proctor for Edwards Lifesciences Inc. and has received honoraria payment. Holger Eggebrecht is a clinical proctor for both Edwards Lifesciences Inc. and Medtronic Inc. and has received honoraria payment.

Correspondence to: Philipp Kahlert, MD, Department of Cardiology, West-German Heart Center Essen, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45122 Essen, Germany. E-mail: Philipp.Kahlert@uk-essen.de

Abstract

Objectives

To evaluate feasibility, safety and efficacy of percutaneous arterial access site closure after transfemoral, transcatheter aortic valve implantation (TF-TAVI) using a single, commercially available six French monofilament suture-mediated vascular closure device (VCD) in “preclosure” technique.

Background

Currently, TF-TAVI is evolving into a completely percutaneous procedure. However, percutaneous access site closure still remains a major technical challenge with room for improvement.

Methods

94 of 144 consecutive patients underwent completely percutaneous TF-TAVI using following technique for access site closure: After puncture of the common femoral artery using fluoroscopy and contralateral angiography for guidance, the VCD was deployed prior further predilatation of the vessel and insertion of the large-bore introducer sheath. At the end of the procedure, the preloaded sutures were tied for final hemostasis and crossover angiography was used for postprocedural evaluation of the access vessel.

Results

Application of the VCD was technically successful in all cases, resulting in an efficient hemostasis with cessation of any bleeding within 10 min of final knot-tying in 83 of the 94 patients, and there was only one closure-failure with continuous bleeding despite prolonged manual compression requiring endovascular treatment. In addition, we observed four closure-related access vessel stenoses of hemodynamic relevance requiring endovascular treatment in three and surgical repair in one patient. However, interventional and surgical repair was not associated with death or irreversible end-organ damage and all patients recovered without sequelae.

Conclusion

“Preclosure” of the arterial access site with a single six French suture-mediated VCD is relatively easy, safe and efficient method for access site closure after TF-TAVI which, along with ongoing profile reductions of TAVI devices, should further simplify and broaden the way toward a routine, completely percutaneous procedure. © 2012 Wiley Periodicals, Inc.

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