Suture or Device? A Real-World Analysis of the Closure Strategies in Patients Undergoing LAA Occlusion

<b>Background</b>: Left atrial appendage occlusion (LAAO) is a valuable alternative to long-term anticoagulation in patients with atrial fibrillation (AF) and a high bleeding risk. However, effective vascular closure following large-bore venous access remains a clinical challenge, particularly in patients with multiple comorbidities. This study compares two venous closure techniques-Z-sutures and the suture-mediated ProGlide™ device-regarding their safety and efficacy in patients undergoing LAAO. <b>Methods</b>: We conducted a single-center observational study including 163 patients treated with LAAO between 2021 and 2024. Closure was achieved via a Z-suture (<i>n</i> = 126) or the ProGlide™ (<i>n</i> = 37) based on operator preference. The primary endpoint was clinically relevant bleeding (BARC ≥ 2). The secondary endpoints included 30-day mortality and hospital stay duration. <b>Results</b>: The Z-suture group included older and more comorbid patients. Despite these differences, the bleeding rates were comparable between groups. Clinically relevant bleeding was infrequent (Z-suture: 12.6%; ProGlide™: 13.5%). No 30-day deaths occurred in either group, and their hospital stay durations were similar. <b>Conclusions</b>: Both the Z-suture and ProGlide™ techniques demonstrated comparable safety and efficacy. Due to their simplicity and potential cost advantage, Z-sutures may be a practical alternative in routine care for high-risk patients.