Comparison of an innovative hybrid closure technique versus conventional vascular closure strategy in large bore access during mechanical hemodynamic support for high risk percutaneous coronary intervention

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Conference Proceeding

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Publication Title

J Am Coll Cardiol


BACKGROUND Percutaneous hemodynamic supportwith use of the Impella CP device is increasingly utilized during high-risk percutaneous coronaryintervention (HRPCI). We sought to compare a novel hybrid technique combining two Perclose inconjunction with one Angioseal vascular closuredevice (VCD) to a conventional strategy utilizing either a Perclose or Angioseal VCD alone in achieving large-bore arteriotomy closure after removal of the Impella CP post PCI. METHODS 23 patients who received the hybrid access site closure (group A) were compared to 23 similar patients who received conventional access site closure (group B) after HRPCI with Impella support from 9/2014 to 1/2017. Hybrid closure technique was performed with pre-deployment of 2 Perclose VCDs prior to Impella insertion. Impella was removed at end of HRPCI, and 0.035” wire was advanced, followed by sheath removal, advancement of the Perclose sutures, and deployment of an 8 Fr Angio-Seal VCD followed by final clinching of Perclose VCD sutures. Demographic, hemodynamic and clinical outcome data were collected and analyzed. RESULTS Baseline and clinical demographics were similar between both groups. There was significantly higher incidence of immediate manual compression in the conventional access closure group (9/23 [39%]) as compared to the hybrid access closure group (3/23 [13%]), p = 0.044. There was a trend towards more in-hospital access-site related bleeding in the conventional access closure group (6/23 [26%]) as compared to the hybrid access closure group (2/21 [9%]), p = 0.243. Group A and B had similar incidence of local hematoma formation (13% vs 13%, p = 1.0), pseudoaneurysm (4.3% vs 4.3%, p = 1.0), blood transfusions required (13% vs 17.4%, p = 1.0). No patients developed infection, acute limb ischemia or required repeat VCD or vascular surgery. In-hospital survival was 100% in both groups. CONCLUSION The novel hybrid closure with 2 Perclose and 1 Angioseal VCD was safe and effective for large bore vascularaccess during Impella- supported HRPCI and was associated with less incidence of immediate manual compression and a trend towards less in-hospital access-site related bleeding as compared to conventional vascular access closure.





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