Preclosure of large bore venous access sites in patients undergoing transcatheter mitral replacement and repair

Authors

Mustafa Mohammed, Henry Ford HealthFollow
Paul Nona, Henry Ford HealthFollow
Elian D. Abou Asala, Henry Ford HealthFollow
Michael Chiang, Henry Ford HealthFollow
Alejandro Lemor, Henry Ford HealthFollow
Brian P. O'Neill, Henry Ford HealthFollow
Tiberio Frisoli, Henry Ford HealthFollow
James Lee, Henry Ford HealthFollow
Dee Dee Wang, Henry Ford HealthFollow
William W. O'Neill, Henry Ford HealthFollow
Marvin H. Eng, Henry Ford HealthFollow
Pedro A. Villablanca, Henry Ford HealthFollow

Recommended Citation

Mohammed M, Nona P, Abou Asala E, Chiang M, Lemor A, O'Neill B, Frisoli T, Lee J, Wang DD, O'Neill WW, Eng M, and Villablanca PA. Preclosure of large bore venous access sites in patients undergoing transcatheter mitral replacement and repair. Catheter Cardiovasc Interv 2022.

Document Type

Article

Publication Date

5-14-2022

Publication Title

Catheterization and cardiovascular interventions

Abstract

OBJECTIVE: We aim to report on the efficacy and safety of large bore venous access (LBVA) preclosure with Perclose™ (Abbott Vascular Devices) suture-mediated device use following transcatheter edge-to-edge (TEER) and replacement (TMVR).

BACKGROUND: Patients requiring TEER and TMVR require LBVA. Clinical outcome data on the use of suture-mediated devices for LBVA site closure are limited.

METHODS: Between 2012 and 2019, 354 consecutive high-risk patients with mitral valvular heart disease underwent TEER (n = 287) with MitraClip and TMVR (n = 67) with Edwards Sapien Valves. Patients had LBVA with 24 or 16 French sheaths. All patients underwent preclosure of LBVA except for one that underwent manual hemostasis.

RESULTS: There were no closure device failures. None of the cases required surgical repair of the access site following venous preclosure. Two cases had large hematomas (>6 cm) following Perclose in each group. Six cases had small hematomas (2 cm) with three in each group. There was one major bleeding using Mitral Valve Academic Research Consortium 2 definition (retroperitoneal bleed from arterial puncture) unrelated to the venous closure. Transfusion related to vascular access complication was required in five cases. There were two immediate acute deep venous thromboses postprocedure; one of which occurred after preclosure. There were no arteriovenous malformations, pseudoaneurysms, or access site infections reported following Perclose.

CONCLUSION: In this large sample size analysis, Proglide preclosure technique is a feasible and safe alternative approach to achieving hemostasis after removal of LBVA sheaths in patients undergoing TEER and TMVR. Randomized trials are needed to compare the different modalities of hemostasis.

PubMed ID

35568977

ePublication

ePub ahead of print