Affiliation:
1. Department of Cardiology Royal Papworth Hospital NHS Foundation Trust Cambridge UK
2. Imperial College Healthcare NHS Trust London UK
3. Clinical Cardiology and Heart Failure Unit Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT) Palermo Italy
Abstract
AbstractBackgroundProGlide is a percutaneous suture‐mediated closure device used in arterial and venous closure following percutaneous intervention. Risk of vascular complications from use, particularly related to failure in hemostasis, or acute vessel closure, remains significant and often related to improper suture deployment. We describe a technique of ultrasound‐guided ProGlide deployment in transfemoral transcatheter aortic valve implantation (TF‐TAVI).AimsThe aim of this study is to assess vascular outcomes for ultrasound‐guided deployment of ProGlide vascular closure devices in patients undergoing TF‐TAVI.MethodsWe collected relevant clinical data of patients undergoing TAVI in a large volume centre. Primary outcome: main access Valve Academic Research Consortium 3 (VARC‐3) major vascular complication. Secondary outcome: any major/minor VARC‐3 vascular complication, its type (bleed or ischemia), and treatment required (medical, percutaneous, or surgical). We performed inverse weighting propensity score analysis to compare the population undergoing ultrasound‐guided versus conventional ProGlide deployment for main TAVI access. Ultrasound technique for ProGlide insertion was performed as described below.ResultsFive hundred and seventeen patients undergoing TF‐TAVI were included.Primary outcome: In 126 (ultrasound‐guided) and 391 (conventional ProGlide insertion), 0% versus 1.8% (p < 0.001) had a major VARC‐3 vascular complication, respectively.Secondary outcome: 0.8% (one minor VARC‐3 bleed) vs 4.1% (13 bleeds and three occlusions) had any VARC‐3 vascular complication (major and minor) (p < 0.001). Surgical treatment of vascular complication was required in 0.8% versus 1.3% (p = NS).ConclusionsUltrasound‐guided deployment of ProGlide for vascular closure reduced the risk of major vascular complications in a large population undergoing TAVI.