Two different hybrid vascular access closure strategies post transcatheter aortic valve implantation

Abstract Background The hybrid strategy combining plug-based and suture-based vascular closure devices (VCD) was introduced as a promising technique for vascular access hemostasis after transcatheter aortic valve implantation (TAVI) with satisfactory outcomes. However, data comparing two plug-based VCDs each in the combination with a suture-based VCD, namely ProGlide/FemoSeal (P/FS) with ProGlide/AngioSeal (P/AS) VCDs, is still lacking. Aim To compare the 30-day outcome of the hybrid strategy using P/AS versus P/FS for vascular access site closure after TAVI. Methods A retrospective single Centre observational study included 608 patients recruited from a prospective TAVI registry between 2016 and 2022. The composite endpoint was defined as any VCD related major vascular complications and/or bleeding more than type 1 according to Valve Academic Research Consortium (VARC-3) criteria. Results The current study reported a significantly higher rate of composite endpoint in P/AS group, which was driven by higher rate of major bleeding (5.4% vs 1.4%, p=0.036). We also found a higher rate of VCD related minor bleeding in P/AS group (16.3% vs 8.1%, p=0.013). Successful access site hemostasis was achieved in 83.1% of P/FS group versus 71.7% in P/AS group (p=0.006). The presence of anterior wall calcification at the access site was significantly associated with the composite endpoint (adj OR 2.49; 95% CI (1.08 – 5.75), p=0.032). Conclusions The hybrid strategy for large bore vascular access closure using P/FS showed a potentially better 30-day outcomes compared with P/AS. The presence of anterior calcification at the access site carries a significant risk of VCD related complications.