https://doi.org/10.1007/s00392-025-02625-4
1Universitätsklinikum Essen Klinik für Kardiologie und Angiologie Essen, Deutschland; 2Herz-Zentrum Bodensee Kardiologie Konstanz, Deutschland; 3Deutsches Herzzentrum München Klinik für Herz- und Gefäßchirurgie München, Deutschland; 4HELIOS Klinikum Siegburg Herzzentrum Siegburg, Klinik für Kardiologie, Angiologie Siegburg, Deutschland
Background: Plug-based vascular closure devices (Pb-VCD) and suture-based vascular closure devices (Sb-VCD) are used for percutaneous vascular access site closure during transcatheter aortic valve replacement (TAVR). Until now, no clear superiority of either device was shown in studies comparing 18F VCDs solely. However, there is no data exclusively comparing the 14F Pb-VCDs against Sb-VCDs after novel 14F low-profile third generation heart valve delivery sheath use with focus on vascular complications.
Methods: We performed a retrospective, propensity score matched comparison of patients receiving either the 14F Pb-VCD or the Sb-VCD after 14F low-profile third generation heart valve delivery sheath use during TAVR. Valve academic research consortium-3 (VARC-3) criteria were used to define the primary endpoint of major and minor vascular complications at the access site. Secondary endpoints included length of hospital stay and in-hospital mortality.
Results: 215 (Sb-VCD) and 169 (Pb-VCD) patients were included in propensity score matching and resulted in 69 matched patient pairs. The primary endpoint of major vascular complications was comparable between the groups (8.7% (Sb-VCD) versus (vs.) 5.8% (Pb-VCD), p=0.511), whereas minor vascular complications were more frequent in the Pb-VCD group (2.9% vs. 11.6%, p=0.049). Secondary endpoints of length of hospital stay (p=0.270) and in-hospital mortality (p=0.366) were balanced between the groups
Conclusion: 14F Pb-VCDs are associated with significantly higher rates of VARC-3 defined minor vascular complications after 14F delivery sheath utilisation during TAVR, not leading to increased in-hospital patients’ mortality. Adequate vascular closure following transfemoral TAVR remains of high clinical significance and continuous efforts are needed to optimize vascular access and closure strategies.