1
|
Boussofara A, Godin M, Canville A, Baala B, Berland J, Koning R, Landolff Q. Assessment of the MANTA closure device in real-life transfemoral transcatheter aortic valve replacement: A single-centre observational study. Catheter Cardiovasc Interv 2024; 103:650-659. [PMID: 38407552 DOI: 10.1002/ccd.30969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 11/30/2023] [Accepted: 01/31/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND Vascular complications increase morbidity and mortality in transcatheter aortic valve replacement (TAVR). Data involving suture-based percutaneous vascular closure devices (VCDs) have been extensive. Although promising, data regarding the efficacy and safety of the MANTA VCD (Teleflex) are scarce. We sought to assess the safety and effectiveness of the MANTA device in a real-life unselected cohort of patients undergoing transfemoral-TAVR (TF-TAVR). METHODS This single-center retrospective observational study included a cohort of consecutive patients with severe aortic stenosis (AS) treated by our team using TAVR between January 2020 to December 2022. The primary outcome measure was access-related major and minor vascular complications according to the Valve Academic Research Consortium (VARC-3) definition criteria. RESULTS From January 2020 to December 2022, a total of 347 patients underwent TF-TAVR were treated using the MANTA 18 Fr VCD system for vascular closure. Mean age was 82.4 ± 6.1 years (56-98 years). There were no significant differences in preoperative and procedural characteristics between patients with and without VCD-related major vascular complications. Access site-related major and minor vascular complications occurred in 20 of 347 patients (5.7%). Overall, major vascular complications occurred in 5 patients (1.4%) and device failure was seen in 17 patients (4.9%). CONCLUSION This French real world evaluation of large-bore arteriotomy closure in TF-TAVR indicated that MANTA VCD is a feasible alternative with an acceptable low rate of access-site-related complications.
Collapse
Affiliation(s)
| | - Matthieu Godin
- Department of Cardiology, Clinique Saint Hilaire, Rouen, France
| | | | - Brahim Baala
- Department of Cardiology, Clinique Saint Hilaire, Rouen, France
| | - Jacques Berland
- Department of Cardiology, Clinique Saint Hilaire, Rouen, France
| | - René Koning
- Department of Cardiology, Clinique Saint Hilaire, Rouen, France
| | | |
Collapse
|
2
|
Murthy K, Kumar J R, Kaur N, Chadha A, Chauhan R, Chadha D. Suture-Based Vascular Closure Versus Surgical Closure of Large Bore Arteriotomies: A Real-World Experience. Cureus 2024; 16:e54856. [PMID: 38533167 PMCID: PMC10964123 DOI: 10.7759/cureus.54856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2024] [Indexed: 03/28/2024] Open
Abstract
INTRODUCTION With the introduction of transcatheter aortic valve implantation (TAVI), endovascular abdominal aortic aneurysm repair (EVAR), thoracic endovascular aortic aneurysm repair (TEVAR), and frequent use of left ventricular assist devices in complicated percutaneous coronary interventions, the use of large bore arterial access has become a necessity. In the index study, we compared the percutaneous closure of large arteriotomies with open surgical (OS) closure. METHODS It was a prospective study in which we compared the technical success and vascular complication rate associated with the use of a suture-based vascular closure device (VCD): Perclose ProGlide (PP) with that of OS closure. The study was carried out at Command Hospital Air Force, Bengaluru, India, from January 1, 2016, to December 31, 2020. The inclusion criteria were any percutaneous intervention involving large bore arterial access (≥12 French (F) sheath). The exclusion criteria were any condition where a persistent need for vascular access at the end of the procedure was required. We noted the baseline characteristics and type of anesthesia for all patients. The primary outcome was technical success and major vascular complications, which included major local site bleeding: Bleeding Academic Research Consortium (BARC) 3 or more, failed hemostasis requiring a second intervention, and acute vessel occlusion. Total time taken for the procedure (TTP), time to ambulation (TTA), and time to discharge post-procedure (TTD) were noted for each patient. The secondary outcomes were any bleeding other than major, local hematoma sized >5 cm at 24 hours, pseudo aneurysm formation at 30 days, and acute limb ischemia at 30 days. RESULTS A total of 120 patients (PP: 60 (males: 54, females: 6), OS: 60 (males: 50, females: 10)) were included in this study. The mean age of patients was comparable in both groups (PP: 71.8 ± 9.62 years and OS: 71.0 ± 7.76 years, p-value: 0.63). Total large arteriotomies (mean size: 18.03F ± 3.34) closed were 184 (PP: 90, OS: 94). The procedures performed were EVAR: 64 (PP: 30, OS: 34), TAVI: 38 (PP: 21, OS: 17), and TEVAR: 18 (PP: 9, OS: 9). All patients in PP group received dual ProGlide with preclose technique. All TEVAR procedures (total arteriotomies: 18) required a vascular sheath of ≥ 24F. There was no statistical difference between the mean size of sheaths used in the two groups. The technical success (PP: 95.55%, OS: 97.87%, 95% CI: -5.78%-10.98%, p-value: 0.48) and rate of major complications were similar in both groups. Three patients in the PP group who had failed hemostasis with two ProGlides were successfully managed with one additional Angioseal (6F) each. The occurrence of hematoma sized larger than 5 cm was significantly more in the PP group compared to the OS group (PP: 7 (7.78%), OS: 0 (0%), p-value: 0.006). While GA was used for all patients who underwent vascular closure with OS, only eight patients (13.33%) in the PP group required GA. The TTP, TTA, and TTD were significantly lower in the PP group as compared to the OS group. CONCLUSION The percutaneous closure of large bore arteriotomies with suture-based VCDs is equally effective and is not associated with increased major vascular complications. In fact, the TTP, TTA, and TTD are significantly lower in the PP group which can translate to better patient comfort and lower costs.
Collapse
Affiliation(s)
- Keshava Murthy
- Cardiology Department, Army Hospital Research and Referral, New Delhi, IND
| | - Ratheesh Kumar J
- Cardiology Department, Army Hospital Research and Referral, New Delhi, IND
| | - Navjyot Kaur
- Cardiology Department, Command Hospital Air Force, Bengaluru, IND
| | - Amitoj Chadha
- Emergency Department, St. John's Medical College, Bengaluru, IND
| | - Rajeev Chauhan
- Cardiology Department, Command Hospital Air Force, Bengaluru, IND
| | | |
Collapse
|
3
|
Cheema T, Venero C, Champaneria S, Younas S, Hadeed Khan MA, Anjum I, Ijaz U, Haider S, Akbar MS, Abdul-Waheed M, Saleem S. Systematic review and meta-analysis comparing Manta device and Perclose device for closure of large bore arterial access. J Vasc Access 2024:11297298231222314. [PMID: 38189215 DOI: 10.1177/11297298231222314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024] Open
Abstract
Data comparing MANTA device with Perclose device for large bore arterial access closure is limited. We performed meta-analysis to compare safety and efficacy of the two devices in large (⩾14 Fr sheath) arteriotomy closure post-TAVR. Relevant studies were identified via PubMed, Cochrane, and EMBASE databases until June, 2022. Data was analyzed using random effect model to calculate relative odds of VARC-2 defined access-site complications and short-term (in-hospital or 30-day) mortality. A total of 12 studies (2 RCT and 10 observational studies) comprising 2339 patients were included. The odds of major vascular complications (OR 0.99, 95% CI 0.51-1.92; p = 0.98); life threatening and major bleeding (OR 0.77, 95% CI 0.45-1.33; p = 0.35); minor vascular complications (OR 1.37, 95% CI 0.63-2.99; p = 0.43); minor bleeding (OR 0.94, 95% CI 0.57-1.56; p = 0.82); device failure (OR 0.74, 95% CI 0.49-1.11; p = 0.14); hematoma formation (OR 0.76, 95% CI 0.33-1.75; p = 0.52); dissection, stenosis, occlusion, or pseudoaneurysm (OR 1.08, 95% CI 0.71-1.62; p = 0.73) and short-term mortality (OR 1.01, 95% CI 0.55-1.84; p = 0.98) between both devices were similar. MANTA device has a similar efficacy and safety profile compared to Perclose device.
Collapse
Affiliation(s)
| | - Carmelo Venero
- University of Kentucky College of Medicine, Lexington, KY, USA
| | | | - Sundas Younas
- Khyber Medical College, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | | | - Ibrar Anjum
- Vassar Brothers Medical Center, Poughkeepsie, NY, USA
| | - Unaiza Ijaz
- Khyber Medical College, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Sajjad Haider
- University of Kentucky College of Medicine, Lexington, KY, USA
| | | | | | - Sameer Saleem
- University of Kentucky College of Medicine, Lexington, KY, USA
| |
Collapse
|
4
|
Sugimura Y, Jandali H, Immohr MB, Katahira S, Minol JP, Lichtenberg A, Akhyari P. Percutaneous Cannulation of Femoral Vessels in Minimally Invasive Cardiac Surgery. Thorac Cardiovasc Surg 2023; 71:641-647. [PMID: 35896438 DOI: 10.1055/s-0042-1745812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
OBJECTIVE Despite the recent trend of access miniaturization in minimally invasive cardiac surgery (MICS) surgical "cut down (CD)" for femoral cannulation remains the standard at many centers. Percutaneous vascular closure (PVC) devices have recently been introduced for minimizing invasiveness during interventional diagnostic and therapy. This report summarizes the initial experience with this new approach in the setting of MICS, with a special focus on safety and advantages. METHODS Percutaneous cannulation with a standard protocol including preoperative computer tomography imaging and intraoperative point-of-care ultrasound guidance was performed in 93 consecutive patients from September 2018 until February 2020, while conventional "CD" procedure performed in 218 patients in the previous period. We analyzed patients' characteristics and compared access site complications of PVC group versus conventional "CD" group. RESULTS As far as operative/postoperative outcome, the duration of intensive care unit stay as well as hospital stay was statistically shorter in PVC compared with CD (CD vs. PVC: 2.74 ± 3.83 vs. 2.16 ± 2.01 days, p < 0.01, 16.7 ± 8.75 vs. 13.0 ± 4.96 days, p < 0.001, respectively). Further, we found no femoral infection or lymphocele in the PVC group, whereas 4 cases of wound complications were observed in the CD group. CONCLUSION According to our results, percutaneous closure system for femoral vessels in MICS seems to be beneficial with the assist of preoperative computed tomography and intraoperative Doppler guidance.
Collapse
Affiliation(s)
- Yukiharu Sugimura
- Department of Cardiac Surgery and Research Group for Experimental Surgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Hassan Jandali
- Department of Cardiology, Angiology and Internal Intensive Care Medicine, Rhineland Clinic, Dormagen, Germany
| | - Moritz Benjamin Immohr
- Department of Cardiac Surgery and Research Group for Experimental Surgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Shintaro Katahira
- Department of Cardiac Surgery and Research Group for Experimental Surgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
- Department of Cardiothoracic Surgery, University Hospital, Tohoku University, Sendai, Japan
| | - Jan-Philipp Minol
- Department of Cardiac Surgery and Research Group for Experimental Surgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Artur Lichtenberg
- Department of Cardiac Surgery and Research Group for Experimental Surgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Payam Akhyari
- Department of Cardiac Surgery and Research Group for Experimental Surgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| |
Collapse
|
5
|
Carande EJ, Salim TS, Chase A, Sekar B, Aldalati O, Hailan A, Khurana A, Smith D, Obaid DR. Computed tomography defined femoral artery plaque composition predicts vascular complications during transcatheter aortic valve implantation. Br J Radiol 2023; 96:20230296. [PMID: 37747290 PMCID: PMC10646661 DOI: 10.1259/bjr.20230296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 07/16/2023] [Accepted: 07/25/2023] [Indexed: 09/26/2023] Open
Abstract
OBJECTIVE Vascular and bleeding complications after transcatheter aortic valve implantation (TAVI) are common and lead to increased morbidity and mortality. Analysis of plaque at the arterial access site may improve prediction of complications. METHODS We investigated the association between demographic and procedural risk factors for Valve Academic Research Consortium (VARC-3) vascular complications in patients undergoing transfemoral TAVI with use of a vascular closure device (ProGlide® or MANTA®) in this retrospective cohort study. The ability of pre-procedure femoral CT angiography to predict complications was investigated including a novel method of quantifying plaque composition of the common femoral artery using plaque maps created with patient specific X-ray attenuation cut-offs. RESULTS 23 vascular complications occurred in the 299 patients in the study group (7.7%). There were no demographic risk factors associated with vascular complications and no statistical difference between use of closure device (ProGlide® vs MANTA®) and vascular complications. Vascular complications after TAVI were associated with sheath size (OR 1.36, 95% CI 1.08-1.76, P 0.01) and strongly associated with CT-derived necrotic core volume in the common femoral artery of the procedural side (OR 17.49, 95% CI 1.21-226.60, P 0.03). CONCLUSION Plaque map analysis of the common femoral artery by CT angiography reveals patients with greater necrotic core are at increased risk of VARC-3 vascular complications. ADVANCES IN KNOWLEDGE The novel measurement of necrotic core volume in the common femoral artery on the procedural side by CT analysis was associated with post-TAVI vascular complications, which can be used to highlight increased risk.
Collapse
Affiliation(s)
- Elliott J. Carande
- Cwm Taff Morgannwg University Health Board, Princess of Wales Hospital, Coity Road, Bridgend, United Kingdom
| | - Tarik S Salim
- Swansea Bay University Health Board, Morriston Hospital, Swansea, United Kingdom
| | - Alexander Chase
- Swansea Bay University Health Board, Morriston Hospital, Swansea, United Kingdom
| | - Baskar Sekar
- Swansea Bay University Health Board, Morriston Hospital, Swansea, United Kingdom
| | - Omar Aldalati
- Swansea Bay University Health Board, Morriston Hospital, Swansea, United Kingdom
| | - Ahmed Hailan
- Swansea Bay University Health Board, Morriston Hospital, Swansea, United Kingdom
| | - Ayush Khurana
- Swansea Bay University Health Board, Morriston Hospital, Swansea, United Kingdom
| | - Dave Smith
- Swansea Bay University Health Board, Morriston Hospital, Swansea, United Kingdom
| | | |
Collapse
|
6
|
Zornitzki L, Zahler D, Frydman S, Itach T, Ben-Shoshan J, Halkin A, Bazan S, Arbel Y, Konigstein M, Finkelstein A, Banai S, Steinvil A. Vascular Complications in Transcatheter Aortic Valve Replacement With Plug-Based vs Suture-Based Closure Devices. Can J Cardiol 2023; 39:1528-1534. [PMID: 37419247 DOI: 10.1016/j.cjca.2023.06.425] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 06/27/2023] [Accepted: 06/29/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND There are conflicting data regarding the efficacy and safety of suture vs plug-based vascular closure devices (VCDs) for large-bore catheter management in patients undergoing transcatheter aortic valve replacement (TAVR). We compared the rates of vascular complications (VCs) associated with 2 commonly used VCDs in a large cohort of patients undergoing TAVR. METHODS We conducted a single-centre, all-comer, prospective registry study, enrolling patients undergoing TAVR for symptomatic severe aortic stenosis (AS) between the years 2009 and 2022. Clinical outcomes were compared between patients undergoing closure of the femoral access point using the MANTA VCD (M-VCD) (Teleflex, Wayne, PA) vs the ProGlide VCD (P-VCD) (Abbott Vascular, Abbott Park, IL). The main outcome measures were researcher adjudicated events of VARC-2 defined major and minor VCs. RESULTS Overall, 2368 patients were enrolled in the registry; 1315 (51.0% male, 81.0 ± 7.0 years) patients were included in the current analysis. P-VCD was used in 813 patients, whereas M-VCD was used in 502 patients. In-hospital VCs were more frequent in the M-VCD vs the P-VCD group (17.3% vs 9.8%; P < 0.001). This outcome was mainly driven by elevated rates of minor VCs in the M-VCD group, whereas no significant difference was observed for major VCs (15.1% vs 8.4%; P < 0.001 and 2.2% vs 1.5%; P = 0.33, respectively). CONCLUSIONS In patients undergoing TAVR for severe AS, M-VCD was associated with higher rates of VCs. This outcome was mainly driven by minor VCs. The rate of major VCs was low in both groups.
Collapse
Affiliation(s)
- Lior Zornitzki
- Department of Cardiology, Tel Aviv Sourasky Medical Center, affiliated with the School of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Internal Medicine B, Tel Aviv Sourasky Medical Center, affiliated with the School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - David Zahler
- Department of Cardiology, Tel Aviv Sourasky Medical Center, affiliated with the School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shir Frydman
- Department of Cardiology, Tel Aviv Sourasky Medical Center, affiliated with the School of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Internal Medicine B, Tel Aviv Sourasky Medical Center, affiliated with the School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tamar Itach
- Department of Cardiology, Tel Aviv Sourasky Medical Center, affiliated with the School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jeremy Ben-Shoshan
- Department of Cardiology, Tel Aviv Sourasky Medical Center, affiliated with the School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Halkin
- Department of Cardiology, Tel Aviv Sourasky Medical Center, affiliated with the School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Samuel Bazan
- Department of Cardiology, Tel Aviv Sourasky Medical Center, affiliated with the School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaron Arbel
- Department of Cardiology, Tel Aviv Sourasky Medical Center, affiliated with the School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Maayan Konigstein
- Department of Cardiology, Tel Aviv Sourasky Medical Center, affiliated with the School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ariel Finkelstein
- Department of Cardiology, Tel Aviv Sourasky Medical Center, affiliated with the School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shmuel Banai
- Department of Cardiology, Tel Aviv Sourasky Medical Center, affiliated with the School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arie Steinvil
- Department of Cardiology, Tel Aviv Sourasky Medical Center, affiliated with the School of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
7
|
Benic C, Nicol PP, Hannachi S, Gilard M, Didier R, Nasr B. Vascular Complications Following Transcatheter Aortic Valve Implantation, Using MANTA (Collagen Plug-Based) versus PROSTAR (Suture-Based), from a French Single-Center Retrospective Registry. J Clin Med 2023; 12:6697. [PMID: 37892835 PMCID: PMC10607530 DOI: 10.3390/jcm12206697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 09/22/2023] [Accepted: 10/20/2023] [Indexed: 10/29/2023] Open
Abstract
TAVI requires a large-bore arteriotomy. Closure is usually performed by the suture system. Some studies report a vascular complication rate of up to 21%. MANTA is a recently developed percutaneous closure system dedicated to large caliber vessels based on an anchoring system. Early studies report a lower rate of vascular complications with MANTA devices. This single-center retrospective study included all patients who underwent femoral TAVI at the Brest University Hospital from 20 November 2019 to 31 March 2021. The primary endpoint is the rate of vascular complications (major and minor) pre and post-TAVI procedure. In total, 264 patients were included. There were no significant differences in vascular complications (major and minor) between the two groups (13.6% in the MANTA group versus 21.2% in the PROSTAR group; p = 0.105), although there was a tendency to have fewer minor vascular complications in the Manta group (12.1% versus 20.5%; p = 0.067). Manta was associated with a lower rate of bleeding complications (3.8% versus 15.2%; p = 0.002), predominantly minor complications with fewer closure failures (4.5% versus 13.6%; p = 0.01), less use of covered stents (4.5% versus 12.9%; p = 0.016), and with no difference in the need for vascular surgery compared to the Prostar group (1.5% versus 2.3%; p = 0.652). On the other hand, Manta was associated with a higher rate of femoral stenosis (4.5% versus 0%; p = 0.013) without clinical significance (1.5% versus 0%; p = 0.156). The Manta and Prostar devices are equivalent in terms of vascular complications. The Manta, compared to the Prostar, is associated with fewer bleeding complications.
Collapse
Affiliation(s)
- Clément Benic
- Department of Cardiology, University Hospital of Brest, 29200 Brest, France; (P.P.N.); (S.H.); (M.G.); (R.D.)
| | - Pierre Philippe Nicol
- Department of Cardiology, University Hospital of Brest, 29200 Brest, France; (P.P.N.); (S.H.); (M.G.); (R.D.)
| | - Sinda Hannachi
- Department of Cardiology, University Hospital of Brest, 29200 Brest, France; (P.P.N.); (S.H.); (M.G.); (R.D.)
| | - Martine Gilard
- Department of Cardiology, University Hospital of Brest, 29200 Brest, France; (P.P.N.); (S.H.); (M.G.); (R.D.)
| | - Romain Didier
- Department of Cardiology, University Hospital of Brest, 29200 Brest, France; (P.P.N.); (S.H.); (M.G.); (R.D.)
| | - Bahaa Nasr
- Department of Vascular Surgery, University Hospital of Brest, 29200 Brest, France;
| |
Collapse
|
8
|
Mejia E, Cummer E, Morgan GJ, Buckvold S, Mitchell M, Leahy RA, Zablah JE. Percutaneous VA-ECMO from Cannulation to Decannulation: Novel Use of a Vascular Closure Device in Pediatrics. Pediatr Cardiol 2023; 44:1623-1628. [PMID: 37418147 DOI: 10.1007/s00246-023-03222-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/26/2023] [Indexed: 07/08/2023]
Abstract
VA-ECMO can be lifesaving in cardiogenic shock in children. While surgical vascular repair is the current standard of care for decannulation, it comes with notable risks. We present a series of eight patients who underwent decannulation with a collagen plug-based vascular closure device (MANTA) for the common femoral artery. Seven of the patients were successfully decannulated without access site-related vascular complications. One required conversion to surgical cut-down with arterial repair due to device failure. This series demonstrates the successful use of the MANTA device in percutaneous VA-ECMO decannulation in the pediatric population, while highlighting potential technical challenges for success.
Collapse
Affiliation(s)
- Ernesto Mejia
- The Heart Center, Children's Hospital Colorado, University of Colorado, 13123 E 16th Ave, B100, Aurora, CO, 80045, USA
| | - Elaina Cummer
- The Heart Center, Children's Hospital Colorado, University of Colorado, 13123 E 16th Ave, B100, Aurora, CO, 80045, USA
| | - Gareth J Morgan
- The Heart Center, Children's Hospital Colorado, University of Colorado, 13123 E 16th Ave, B100, Aurora, CO, 80045, USA
| | - Shannon Buckvold
- The Heart Center, Children's Hospital Colorado, University of Colorado, 13123 E 16th Ave, B100, Aurora, CO, 80045, USA
| | - Max Mitchell
- The Heart Center, Children's Hospital Colorado, University of Colorado, 13123 E 16th Ave, B100, Aurora, CO, 80045, USA
| | - Ryan A Leahy
- The Heart Center, Children's Hospital Colorado, University of Colorado, 13123 E 16th Ave, B100, Aurora, CO, 80045, USA
| | - Jenny E Zablah
- The Heart Center, Children's Hospital Colorado, University of Colorado, 13123 E 16th Ave, B100, Aurora, CO, 80045, USA.
| |
Collapse
|
9
|
Chaudhuri A. 'Post-Close' Femoral Arterial Haemostasis at Endovascular Aneurysm Repair using a Dedicated Large-Bore Vascular Closure Device: A Prospective Real-World Audit. Cardiovasc Intervent Radiol 2023:10.1007/s00270-023-03437-7. [PMID: 37055544 DOI: 10.1007/s00270-023-03437-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 03/28/2023] [Indexed: 04/15/2023]
Abstract
PURPOSE Percutaneous access for endovascular aneurysm repair (EVAR) is commonplace, with its attendant benefits. The combination of continued reduction in device profile and evolution of vascular closure device (VCD) design drives successful and safe percutaneous EVAR. A new such VCD is the MANTA Large-Bore Closure Device designed in two iterations for closure of arterial defects from 10 to 25F. We present a prospective audit of 131 large-bore femoral closures using an 'all-comers' approach to device selection. MATERIALS AND METHODS One hundred and thirty-one large-bore femoral arterial defects were analysed. Both 14F and 18F MANTA VCDs were deployed in this series as per instructions for use. Primary objectives were technical success, particularly successful deployment, and haemostasis achieved. Failures were denoted as failure to deploy; failure to achieve haemostasis was denoted as active bleeding, haematoma, or pseudoaneurysm formation requiring intervention. Later complications assessed were vessel occlusion/thrombosis or stenosis. RESULTS Seventy-six patients (65 males and 11 females, age 75.2 ± 8.7 years) underwent a range of procedures including EVAR (n = 66), TEVAR (n = 2), and reinterventions (n = 8) requiring large-bore percutaneous femoral arterial access in 131 groins. Of these, the 14F MANTA VCD was used in 61 closures (defects ranging from 12 to 18F) and the 18F in 70 closures (defects ranging from 16 to 24F). Deployments achieved successful haemostasis in 120 (91.6%), and failures occurred in 11(8.4%) groins. CONCLUSIONS This study indicates that a post-close approach using the novel MANTA Large-Bore Closure Device can be undertaken successfully to close a range of large-bore femoral arterial defects at EVAR/TEVAR with an acceptable rate of complications.
Collapse
Affiliation(s)
- A Chaudhuri
- Bedfordshire-Milton Keynes Vascular Centre, Bedfordshire Hospitals NHS Foundation Trust, Kempston Road, Bedford, MK42 9DJ, UK.
| |
Collapse
|
10
|
Diamantopoulos A, Nourzaie R, Mulholland D, Dolan SG, Ahmed I, Gkoutzios P, Thulasidasan N, Theodoulou I, Sabharwal T. Safety and efficacy of the Mynx Control vascular closure device in peripheral arterial procedures: A prospective study. Vascular 2023; 31:369-374. [PMID: 34958621 DOI: 10.1177/17085381211062745] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES This article aims to present a prospective study investigating the safety and efficacy of the Mynx Control extravascular closure device (Cordis Corporation, FL, USA), for femoral arterial closure in patients undergoing peripheral arterial procedures. METHODS Between January 2020 and February 2021, 100 Mynx Control devices were deployed in 91 consecutive patients (mean age: 67.5 ± 16.9 years) who underwent peripheral arterial procedures. We used ultrasound and/or fluoroscopy during Mynx Control deployment and ultrasound post-procedure to detect complications. Femoral artery punctures included 62 (62%) antegrade and 38 (38%) retrograde punctures. The mean activated clotting time at time of device deployment was 221s. The primary endpoints were technical success, device failure, and complication rates up to 30 days. RESULTS A 5F vascular sheath was used in 43 cases (43%) (36 (36%) 6F and 21 (21%) 7F). The majority of our cases had antegrade access (62%). Overall technical success rate was 97% in both antegrade and retrograde cases. In total, there were 4 minor complications: 3 (3%) cases of pseudoaneurysm and 1 (1%) case of haematoma. No major complications were recorded post-procedure or 30 days post index procedure. CONCLUSION The Mynx Control vascular closure device is safe and effective in achieving haemostasis in patients undergoing antegrade and retrograde peripheral angioplasty procedures.
Collapse
Affiliation(s)
- Athanasios Diamantopoulos
- Department of Interventional Radiology, 8945Guys' and St. Thomas' NHS Foundation Trust, London, UK.,School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, Kings College London, London, UK
| | - Romman Nourzaie
- Department of Interventional Radiology, 8945Guys' and St. Thomas' NHS Foundation Trust, London, UK
| | - Doug Mulholland
- Department of Interventional Radiology, 8945Guys' and St. Thomas' NHS Foundation Trust, London, UK
| | - Steven G Dolan
- Department of Interventional Radiology, 8945Guys' and St. Thomas' NHS Foundation Trust, London, UK
| | - Irfan Ahmed
- Department of Interventional Radiology, 8945Guys' and St. Thomas' NHS Foundation Trust, London, UK
| | - Panos Gkoutzios
- Department of Interventional Radiology, 8945Guys' and St. Thomas' NHS Foundation Trust, London, UK
| | - Narayanan Thulasidasan
- Department of Interventional Radiology, 8945Guys' and St. Thomas' NHS Foundation Trust, London, UK
| | - Iakovos Theodoulou
- Department of Interventional Radiology, 8945Guys' and St. Thomas' NHS Foundation Trust, London, UK
| | - Tarun Sabharwal
- Department of Interventional Radiology, 8945Guys' and St. Thomas' NHS Foundation Trust, London, UK
| |
Collapse
|
11
|
Kmiec L, Zerdzitzki M, Schmid C, Debl K, Sossalla S, Hilker M, Holzamer A. Evaluation of the MANTA Vascular Closure Device in Transfemoral TAVI. Thorac Cardiovasc Surg 2023; 71:84-93. [PMID: 34176110 DOI: 10.1055/s-0041-1730972] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The MANTA vascular closure device (VCD) is a novel collagen plug-based VCD for large bore arteriotomies. The current literature regarding complication rates of this device is quite variable and mostly limited to relatively small case series. METHODS This study is retrospective analysis of the MANTA VCD-related main access site complications according to Valve Academic Research Consortium-2 (VARC-2) criteria during the hospital stay. Particular attention was paid to the detailed analysis of multislice computed tomography with regard to the anatomy of the access vessel and the puncture site itself. RESULTS A total of 524 patients underwent transfemoral transcatheter aortic valve implantation (TF TAVI) including the use of the MANTA device (18F) for percutaneous vascular closure. A group of 22 patients was excluded from the study due to incomplete imaging data. During the study period, we observed 28 major (5.6%) and five minor (1.0%) MANTA device-related vascular complications. There was no patient death related to these adverse events. Female gender, vessel angulation at the puncture site, and at least moderate calcification of the dorsal vessel segment were identified as independent predictors for major complications. CONCLUSIONS The MANTA device is a feasible option for vascular closure of large bore arteriotomies in patients undergoing TF TAVI or other percutaneous transfemoral interventions. Furthermore, we have identified novel predictors for device failure/complications that should be taken into account for selection of the appropriate closure device. To our knowledge, this report is one of the largest case series analyzing the use of the MANTA VCD.
Collapse
Affiliation(s)
- Lukasz Kmiec
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Matthaeus Zerdzitzki
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Christof Schmid
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Kurt Debl
- Department of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Samuel Sossalla
- Department of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Michael Hilker
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Andreas Holzamer
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| |
Collapse
|
12
|
Sedhom R, Dang AT, Elwagdy A, Megaly M, Elgendy IY, Zahr F, Gafoor S, Mamas M, Elbadawi A. Outcomes with plug-based versus suture-based vascular closure device after transfemoral transcatheter aortic valve replacement: A systematic review and meta-analysis. Catheter Cardiovasc Interv 2023; 101:817-827. [PMID: 36802100 DOI: 10.1002/ccd.30597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 10/25/2022] [Accepted: 02/04/2023] [Indexed: 02/21/2023]
Abstract
BACKGROUND Studies comparing plug-based (i.e., MANTA) with suture-based (i.e., ProStar XL and ProGlide) vascular closure devices (VCDs) for large-bore access closure after transcatheter aortic valve replacement (TAVR) have yielded mixed results. AIMS To examine the comparative safety and efficacy of both types of VCDs among TAVR recipients. METHODS An electronic database search was performed through March 2022 for studies comparing access-site related vascular complications with plug-based versus suture-based VCDs for large-bore access site closure after transfemoral (TF) TAVR. RESULTS Ten studies (2 randomized controlled trials [RCTs] and 8 observational studies) with 3113 patients (MANTA = 1358, ProGlide/ProStar XL = 1755) were included. There was no difference between plug-based and suture-based VCD in the incidence of access-site major vascular complications (3.1% vs. 3.3%, odds ratio [OR]: 0.89; 95% confidence interval [CI]: 0.52-1.53). The incidence of VCD failure was lower in plug-based VCD (5.2% vs. 7.1%, OR: 0.64; 95% CI: 0.44-0.91). There was a trend toward a higher incidence of unplanned vascular intervention in plug-based VCD (8.2% vs. 5.9%, OR: 1.35; 95% CI: 0.97-1.89). Length of stay was shorter with MANTA. Subgroup analyses suggested significant interaction based on study designs such that there was higher incidence of access-site vascular complications and bleeding events with plug-based versus suture-based VCD among RCTs. CONCLUSION In patients undergoing TF-TAVR, large-bore access site closure with plug-based VCD was associated with a similar safety profile as suture-based VCD. However, subgroup analysis showed that plug-based VCD was associated with higher incidence of vascular and bleeding complications in RCTs.
Collapse
Affiliation(s)
- Ramy Sedhom
- Division of Cardiology, Loma Linda University Health, Loma Linda, California, USA
| | - Alexander T Dang
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, USA
| | - Amr Elwagdy
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York, USA
| | - Michael Megaly
- Division of Cardiology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Islam Y Elgendy
- Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, Kentucky, USA
| | - Firas Zahr
- Division of Cardiology, Oregon Health and Science University, Portland, Oregon, USA
| | - Samir Gafoor
- Swedish Heart and Vascular Institute, Seattle, Washington, USA
| | - Mamas Mamas
- Centre for Prognosis Research, Keele Cardiovascular Research Group, Keele University, Keele, UK.,Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Ayman Elbadawi
- Division of Cardiology, Baylor College of Medicine, Houston, Texas, USA
| |
Collapse
|
13
|
Dumpies O, Jobs A, Obradovic D, van Wiechen M, Hartung P, Rotta Detto Loria J, Wilde J, Majunke N, Kiefer P, Noack T, Thiele H, van Mieghem N, Desch S, Abdel-Wahab M. Comparison of plug-based versus suture-based vascular closure for large-bore arterial access: a collaborative meta-analysis of observational and randomized studies. Clin Res Cardiol 2023; 112:614-625. [PMID: 36749418 PMCID: PMC10160216 DOI: 10.1007/s00392-022-02145-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 12/19/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND Large-bore arteriotomies can be percutaneously closed with suture-based or plug-based vascular closure device (VCD) strategies. The efficacy of both techniques remains controversial. AIMS We conducted a meta-analysis of comparative studies between both VCD strategies, focusing on the most commonly applied VCDs (MANTA and ProGlide). METHODS We searched MEDLINE, the Cochrane Central Register of Controlled Trials and Google scholar for observational studies (OS) and randomized controlled trials (RCT) comparing vascular closure with the MANTA-based and the ProGlide-based technique. The principal endpoint of this analysis was access-site related vascular complications. Both study types were analyzed separately. RESULTS Access-site related vascular complications were less frequent after vascular closure with the MANTA technique in the analysis of OS (RR 0.61 [95%CI 0.43-0.89], p = 0.01, I2 = 0%), but more frequent in the analysis of RCT data (RR 1.70 [95%CI 1.16-2.51], p = 0.01, I2 = 0%). Both data sets provided no significant difference between the VCD techniques in terms of overall bleeding events (OS: RR 0.57 [95%CI 0.32-1.02], p = 0.06, I2 = 70%; and RCT: RR 1.37 [95%CI 0.82-2.28], p = 0.23, I2 = 30%). RCT data showed that endovascular stenting or vascular surgery due to VCD failure occurred more often after MANTA application (RR 3.53 [95%CI 1.07-11.33], p = 0.04, I2 = 0%). CONCLUSIONS While OS point to favorable outcomes for large-bore vascular closure with the MANTA-based technique, RCT data show that this strategy is associated with more access-site related vascular complications as well as endovascular stenting or vascular surgery due to device failure compared with the ProGlide-based technique.
Collapse
Affiliation(s)
- Oliver Dumpies
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Alexander Jobs
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Luebeck/Kiel, Hamburg, Germany
| | - Danilo Obradovic
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Maarten van Wiechen
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Philipp Hartung
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | | | - Johannes Wilde
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Nicolas Majunke
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Philipp Kiefer
- Department of Cardiac Surgery, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Thilo Noack
- Department of Cardiac Surgery, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Holger Thiele
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Nicolas van Mieghem
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Steffen Desch
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Luebeck/Kiel, Hamburg, Germany
| | - Mohamed Abdel-Wahab
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany.
| |
Collapse
|
14
|
Sakata T, Kuno T, Fujisaki T, Yokoyama Y, Misumida N, Sugiura T, Latib A. Selection of Vascular Closure Devices in Transcatheter Aortic Valve Replacement: Systematic Review and Network Meta-Analysis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 46:78-84. [PMID: 35970699 DOI: 10.1016/j.carrev.2022.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 08/08/2022] [Indexed: 01/14/2023]
Abstract
Various vascular closure devices (VCDs) are commonly used for percutaneous transcatheter aortic valve replacement (TAVR). However, superiority and safety profile among them remain unclear. We compared periprocedural complications among various VCDs in patients undergoing TAVR. PubMed and EMBASE were searched through January 2022 to identify clinical studies comparing any 2 VCDs of Prostar, Proglide and MANTA in patients who underwent TAVR. Studies using surgical cut-down or alternative access other than transfemoral approach were excluded. We analyzed the odds ratios (ORs) of vascular complications (VC), bleeding, acute kidney injury and all-cause mortality using a network meta-analysis. All outcomes were defined by Valve Academic Research Consortium 2 criteria. Two randomized controlled trials and 15 observational studies were identified, yielding a total of 11,344 patients including Prostar (n = 4499), Proglide (n = 5705), or MANTA group (n = 1140). The rates of major VC and life-threatening and major bleeding were significantly lower in Proglide compared to Prostar (OR [95 % CI] = 0.54 [0.32-0.89], 0.68 [0.52-0.90], and 0.49 [0.26-0.95], respectively). There was no significant difference in major VC and bleeding between Proglide and MANTA groups. Proglide was associated with a lower rate of acute kidney injury (0.56 [0.34-0.92]) and red blood cell transfusion (0.39 [0.16-0.98]) compared to Prostar. There was no significant difference in additional interventions and 30-day overall mortality among three groups. In this network meta-analysis of VCD in patients undergoing TAVR, MANTA and Proglide had comparable outcomes while Proglide appears superior to Prostar in terms of major VC and bleeding.
Collapse
Affiliation(s)
- Tomoki Sakata
- Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Toshiki Kuno
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, USA.
| | - Tomohiro Fujisaki
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Morningside and West, New York, USA
| | - Yujiro Yokoyama
- Department of Surgery, St. Luke's University Health Network, PA, USA
| | - Naoki Misumida
- Division of Cardiovascular Medicine, Gill Heart and Vascular Institute, University of Kentucky, Lexington, USA
| | - Tadahisa Sugiura
- Department of Cardiothoracic & Vascular Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, USA
| | - Azeem Latib
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, USA
| |
Collapse
|
15
|
Doshi R, Vasudev R, Guragai N, Patel KN, Kumar A, Majmundar M, Doshi P, Patel P, Shah K, Santana M, Roman S, Vallabhajosyula S, Virk H, Bikkina M, Shamoon F. Clinical outcomes of MANTA vs suture-based vascular closure devices after transcatheter aortic valve replacement: An updated meta-analysis. Indian Heart J 2023; 75:59-67. [PMID: 36640840 PMCID: PMC9986740 DOI: 10.1016/j.ihj.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 01/08/2023] [Accepted: 01/09/2023] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE A recently published randomized control trial showed different results with suture-based vascular closure device (VCD) than plug-based VCD in patients undergoing transfemoral transcatheter aortic valve replacement (TAVR). The learning curve for MANTA device is steep, while the learning curve for suture based VCD is shallow as the devices are quite different. In this meta-analysis, we have compared suture-based (ProGlide and Prostar XL) vs plug-based VCDs (MANTA). METHODS We performed a meta-analysis of all published studies (using PubMed/Medline and Cochrane databases) reporting the clinical outcome of plug-based vs suture-based VCDs in transfemoral TAVR patients. RESULTS We included nine studies with a total of 2865 patients (plug-based n = 1631, suture-based n = 1234). There was no significant difference in primary outcome of all bleeding when using plug-based as opposed to suture-based VCDs (RR 1.14 [0.62-2.06] I2 = 72%). There was no significant difference in the incidence of secondary outcomes between two groups including major life threatening bleeding (RR 1.16 [0.38-3.58] I2 = 65%), major vascular complications (RR 0.84 [0.35-2.00] I2 = 55%), minor vascular complications (RR 1.05 [0.56-1.95] I2 = 42%), pseudo aneurysm (RR 1.84 [0.11-29.98] I2 = 44%), stenosis-dissection (RR 0.98 [0.66-1.47] I2 = 0%), VCD failure (RR 1.71 [0.96-3.04] I2 = 0%), and blood transfusion (RR 1.01 [0.38-2.71], I2 = 61%). CONCLUSION Large bore arteriotomy closure with plug-based VCD was not superior to suture-based VCDs in this transfemoral TAVR population. There was very frequent use of secondary VCDs in suture-based VCD group which is not practical when using MANTA. Additional high-powered studies are required to determine the safety and efficacy of MANTA device.
Collapse
Affiliation(s)
- Rajkumar Doshi
- Department of Cardiology, St Joseph University Medical Center, Paterson, NJ, USA.
| | - Rahul Vasudev
- Department of Cardiology, St Joseph University Medical Center, Paterson, NJ, USA
| | - Nirmal Guragai
- Department of Cardiology, St Joseph University Medical Center, Paterson, NJ, USA
| | - Kunal Nitinkumar Patel
- Department of Internal Medicine, Saint Peter's University Hospital, New Brunswick, NJ, USA
| | - Ashish Kumar
- Department of Internal Medicine Cleveland Clinic Akron General, Akron, OH, USA
| | - Monil Majmundar
- Department of Cardiology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Preet Doshi
- Department of Medicine, MS Ramaiah Medical College, Bengaluru, India
| | - Prem Patel
- Department of Cardiology, St Joseph University Medical Center, Paterson, NJ, USA
| | - Kalpesh Shah
- Department of Cardiology, St Joseph University Medical Center, Paterson, NJ, USA
| | - Melvin Santana
- Department of Cardiology, St Joseph University Medical Center, Paterson, NJ, USA
| | - Sherif Roman
- Department of Cardiology, St Joseph University Medical Center, Paterson, NJ, USA
| | - Saraschandra Vallabhajosyula
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Hartaj Virk
- Department of Cardiology, St Joseph University Medical Center, Paterson, NJ, USA
| | - Mahesh Bikkina
- Department of Cardiology, St Joseph University Medical Center, Paterson, NJ, USA
| | - Fayez Shamoon
- Department of Cardiology, St Joseph University Medical Center, Paterson, NJ, USA
| |
Collapse
|
16
|
Vetrovec GW, Kaki A, Wollmuth J, Dahle TG. Strategies for Reducing Vascular and Bleeding Risk for Percutaneous Left Ventricular Assist Device-supported High-risk Percutaneous Coronary Intervention. Heart Int 2022; 16:105-111. [PMID: 36741103 PMCID: PMC9872781 DOI: 10.17925/hi.2022.16.2.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 12/16/2022] [Indexed: 12/25/2022] Open
Abstract
In patients at high risk for haemodynamic instability during percutaneous coronary intervention (PCI), practitioners are increasingly opting for prophylactic mechanical circulatory support, such as the Impella® heart pump (Abiomed, Danvers, MA, USA). Though Impella-supported high-risk PCI (HRPCI) ensures haemodynamic stability during the PCI procedure, access-related complication rates have varied significantly in published studies. Reported variability in complication rates relates to many factors, including anticoagulation practices, access and closure strategy, post-procedure care and variations in event definitions. This article aims to outline optimal strategies to minimize vascular and bleeding complications during Impella-supported HRPCI based on previously identified clinical, procedural and postprocedural risk factors. Practices to reduce complications include femoral skills training, standardized protocols to optimize access, closure, anticoagulation management and post-procedural care, as well as the application of techniques and technological advances. Protocols integrating these strategies to mitigate access-related bleeding and vascular complications for Impella-supported procedures can markedly limit vascular access risk as a barrier to appropriate large-bore mechanical circulatory support use in HRPCI.
Collapse
Affiliation(s)
- George W Vetrovec
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Amir Kaki
- Division of Cardiology, St. John’s Hospital, Wayne State University, Detroit, MI, USA
| | - Jason Wollmuth
- Providence Heart and Vascular Institute, Providence, OR, USA
| | - Thom G Dahle
- CentraCare Heart & Vascular Center, St. Cloud Hospital, St. Cloud, MN, USA
| | | | | | | | | |
Collapse
|
17
|
Comparison of Suture-Based and Collagen-Based Vascular Closure Devices for Large Bore Arteriotomies-A Meta-Analysis of Bleeding and Vascular Outcomes. J Cardiovasc Dev Dis 2022; 9:jcdd9100331. [PMID: 36286283 PMCID: PMC9604251 DOI: 10.3390/jcdd9100331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 09/15/2022] [Accepted: 09/27/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Large bore access procedures rely on vascular closure devices to minimize access site complications. Suture-based vascular closure devices (S-VCD) such as ProGlide and ProStar XL have been readily used, but recently, newer generation collagen-based vascular closure devices (C-VCD) such as MANTA have been introduced. Data on comparisons of these devices are limited. METHODS PubMed, Scopus and Cochrane were searched for articles on vascular closure devices using keywords, ("Vascular closure devices" OR "MANTA" OR "ProStar XL" OR "ProGlide") AND ("outcomes") that resulted in a total of 875 studies. Studies were included if bleeding or vascular complications as defined by Valve Academic Research Consortium-2 were compared between the two types of VCDs. The event level data were pooled across trials to calculate the Odds Ratio (OR) with 95% CI, and analysis was done with Review Manager 5.4 using random effects model. RESULTS Pooled analyses from these nine studies resulted in a total of 3410 patients, out of which 2855 were available for analysis. A total of 1229 received C-VCD and 1626 received S- VCD. Among the patients who received C-VCD, the bleeding complications (major and minor) were similar to patients who received S-VCD ((OR: 0.70 (0.35-1.39), p = 0.31, I2 = 55%), OR: 0.92 (0.53-1.61), p = 0.77, I2 = 65%)). The vascular complications (major and minor) in patients who received C-VCD were also similar to patients who received S-VCD ((OR: 1.01 (0.48-2.12), p = 0.98, I2 = 52%), (OR: 0.90 (0.62-1.30), p = 0.56, I2 = 35%)). CONCLUSIONS Bleeding and vascular complications after large bore arteriotomy closure with collagen-based vascular closure devices are similar to suture-based vascular closure devices.
Collapse
|
18
|
Eftychiou C, Eteocleous N, Mitsis A, Zittis I, Papadopoulos K, Petrou A, Adamou M, Kounnos C, Bekos C, Avraamides P. Comparison of MANTA vs ProGlide Vascular Closure Device and 30-Day Outcomes in Transfemoral Transcatheter Aortic Valve Implantation. Tex Heart Inst J 2022; 49:487726. [DOI: 10.14503/thij-21-7650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Background
Vascular complications (VCs) after transfemoral transcatheter aortic valve implantation (TAVI) have an increased mortality risk, and vascular closure device (VCD) use is mandatory. The percutaneous MANTA VCD (Teleflex) is a novel collagen-based technology for closure of large-bore arteriotomies. We compared the MANTA VCD with the suture-based ProGlide VCD (Abbott Vascular).
Methods
A retrospective review was performed on all consecutive patients who underwent transfemoral TAVI in our center from January 1, 2015, to February 28, 2021, and 30-day outcomes were recorded. Major adverse cardiovascular events (MACE) were cardiac death, disabling stroke, and/or major VCs. Access site–related VCs were VCs related to the access site vessel from which the transcatheter valve was introduced and advanced.
Results
The MANTA VCD was used in 99 patients and the ProGlide in 224. There was 4.0% MACE in the MANTA group and 4.9% in the ProGlide group (P = .999). Overall VCs were 10.1% vs 7.6%, major VCs were 3.0% vs 2.2%, and minor VCs 7.1% vs 5.4%(P = .753). Access site–related VCs were 5.1% vs 5.8% in the (P = .999), and periprocedural vascular surgical intervention was needed in 6.1% of the MANTA group vs 2.2% of the ProGlide group (P = .099).
Conclusion
There was no significant difference in MACE, mortality, cardiovascular mortality, VCs, access site–related VCs, periprocedural vascular surgical interventions, bleeding, or transfusion rate between the 2 groups. The MANTA VCD group had more periprocedural vascular surgical interventions which did not reach statistical significance.
Collapse
Affiliation(s)
| | | | - Andreas Mitsis
- 1 Cardiology Department, Nicosia General Hospital, Nicosia, Cyprus
| | - Ioannis Zittis
- 1 Cardiology Department, Nicosia General Hospital, Nicosia, Cyprus
| | | | - Andria Petrou
- 2 Anesthesiology Department, Nicosia General Hospital, Nicosia, Cyprus
| | - Maria Adamou
- 3 Blood Bank Department, Nicosia General Hospital, Nicosia, Cyprus
| | - Christos Kounnos
- 4 Vascular Surgery Department, Nicosia General Hospital, Nicosia, Cyprus
| | - Christos Bekos
- 4 Vascular Surgery Department, Nicosia General Hospital, Nicosia, Cyprus
| | | |
Collapse
|
19
|
Montalto C, Munafò AR, Arzuffi L, Soriano F, Mangieri A, Nava S, De Maria GL, Burzotta F, D’Ascenzo F, Colombo A, Latib A, Oreglia JA, Banning AP, Porto I, Crimi G. Large-bore arterial access closure after transcatheter aortic valve replacement: a systematic review and network meta-analysis. EUROPEAN HEART JOURNAL OPEN 2022; 2:oeac043. [PMID: 36117948 PMCID: PMC9472788 DOI: 10.1093/ehjopen/oeac043] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/27/2022] [Indexed: 02/03/2023]
Abstract
Aims As the indications to transcatheter aortic valve replacement (TAVR) expand to patients at increasingly lower risk, procedure-related vascular and bleeding complications events must be minimized. We aimed to evaluate the impact of different large-bore arterial access closure devices on clinical outcomes after TAVR. Methods and results We searched for papers that reported outcomes according to the type of vascular closure device/technique used after TAVR and performed a Bayesian network meta-analysis (NMA). Fifteen studies involving 9259 patients who underwent access site closure using PROSTAR™ XL percutaneous vascular surgical system (Abbott Vascular, Santa Clara, CA, USA), Perclose ProGlide™ suture-mediated closure system (Abbott), or MANTATM vascular closure device (Teleflex, Morrisville, NC, USA) were included. NMA showed MANTA to have the highest likelihood of reducing a primary composite endpoint of intra-hospital death, major vascular complications, and major or life-threatening bleedings [surface under the cumulative ranking curve analysis (SUCRA) 94.8%], but this was mitigated when only randomized clinical trials and propensity-matched cohorts were included (SUCRA 56.1%). The ProGlide showed the highest likelihood to reduce major or life-threatening bleedings, especially with increasing procedural complexity, and the MANTA device to reduce major and minor vascular complications. The ProStar XL device performed poorly in all explored endpoints. Conclusion Available evidence summarized through a NMA shows that ProGlide and MANTA devices appear to be both valid vascular closure devices globally and to be the best options to minimize vascular complications and reduce bleeding in patients undergoing TAVR, respectively.
Collapse
Affiliation(s)
- Claudio Montalto
- Department of Molecular Medicine, University of Pavia, 27100 Pavia, Italy,De Gasperis Cardio Center, Interventional Cardiology Unit, Niguarda Hospital, 20172 Milan, Italy
| | | | | | - Francesco Soriano
- De Gasperis Cardio Center, Interventional Cardiology Unit, Niguarda Hospital, 20172 Milan, Italy
| | | | - Stefano Nava
- De Gasperis Cardio Center, Interventional Cardiology Unit, Niguarda Hospital, 20172 Milan, Italy
| | - Giovanni Luigi De Maria
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Oxford OX3 9DU, UK
| | - Francesco Burzotta
- Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Fabrizio D’Ascenzo
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, 10126 Turin, Italy,Cardiology, Department of Medical Sciences, University of Turin, 10126 Turin, Italy
| | | | - Azeem Latib
- Montefiore Medical Center, New York 10467, USA
| | - Jacopo Andrea Oreglia
- De Gasperis Cardio Center, Interventional Cardiology Unit, Niguarda Hospital, 20172 Milan, Italy
| | - Adrian P Banning
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Oxford OX3 9DU, UK
| | | | - Gabriele Crimi
- Division of Cardiovascular Medicine, Policlinico San Martino, University of Genova, 16132 Genova, Italy
| |
Collapse
|
20
|
Pledget-assisted hemostasis to fix residual access-site bleedings after double pre-closure technique. World J Cardiol 2022. [DOI: 10.4330/wjc.v14.i5.296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
|
21
|
Burzotta F, Aurigemma C, Kovacevic M, Romagnoli E, Cangemi S, Bianchini F, Nesta M, Bruno P, Trani C. Pledget-assisted hemostasis to fix residual access-site bleedings after double pre-closure technique. World J Cardiol 2022; 14:297-306. [PMID: 35702322 PMCID: PMC9157605 DOI: 10.4330/wjc.v14.i5.297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 02/06/2022] [Accepted: 04/24/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The use of pre-closure suture-based devices represents a widely access-site hemostasis technique in percutaneous transfemoral transcatheter-aortic-valve-replacement (TF-TAVR); yet this technique is associated with the risk of a device failure that may result in clinically relevant residual bleeding. Thus, a bailout intervention is needed. So far, the best management of pre-closure device failure has not been recognized.
AIM To report the first clinical results obtained using a novel bailout hemostasis technique for patients with double suture-based vascular closure device failure in the setting of TF-TAVR.
METHODS We developed a “pledget-assisted hemostasis” technique to manage residual access-site bleeding. This consists of the insertion of a surgical, non-absorbable, polytetrafluoroethylene pledget over the sutures of the two ProGlide (Abbott Vascular, CA, United States). The ProGlide’s knot-pushers are used to push down the pledget and the hand-made slipknot to seal the femoral artery leak. This technique was used as a bailout strategy in patients undergoing TF-TAVR with a systematic double pre-closure technique. Post-procedural access-site angiography was systematically performed. In-hospital complications were systematically detected and classified according to Valve Academic Research Consortium-2 criteria.
RESULTS Out of 136 consecutive patients who underwent TF-TAVR, 15 patients (mean age 80.0 ± 7.2 years, 66.7% female) with access-site bleeding after double pre-closure technique failure were treated by pledget-assisted hemostasis. In the majority of patients, 16F sheath was used (n = 12; 80%). In 2 cases (13%), a peripheral balloon was also inflated in the iliac artery to limit blood loss during pledget preparation. Angiography-confirmed hemostasis (primary efficacy endpoint) was achieved in all patients. After the procedure, 1 patient required blood transfusion (2 units), and no other bleeding or major ischemic complication was noticed.
CONCLUSION The “pledget assisted hemostasis” might be considered as a possible bailout technique to treat patients with residual access site bleeding. Further studies are needed to compare this approach with other bail-out techniques.
Collapse
Affiliation(s)
- Francesco Burzotta
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome 00168, Italy
- Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Cristina Aurigemma
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome 00168, Italy
| | - Mila Kovacevic
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Institute of Cardiovascular Diseases of Vojvodina, Cardiology Clinic, Sremska Kamenica, Serbia
| | - Enrico Romagnoli
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome 00168, Italy
| | - Stefano Cangemi
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome 00168, Italy
| | - Francecso Bianchini
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome 00168, Italy
| | - Marialisa Nesta
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome 00168, Italy
| | - Piergiorgio Bruno
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome 00168, Italy
- Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Carlo Trani
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome 00168, Italy
- Università Cattolica del Sacro Cuore, Rome 00168, Italy
| |
Collapse
|
22
|
Meucci F, Stolcova M, Caniato F, Sarraf M, Mattesini A, Di Mario C. The Essentials of Femoral Vascular Access and Closure. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
|
23
|
Kastengren M, Settergren M, Rück A, Feldt K, Saleh N, Linder R, Verouhis D, Meduri CU, BMSc JB, Dalén M. Percutaneous plug-based vascular closure device in 1000 consecutive transfemoral transcatheter aortic valve implantations. Int J Cardiol 2022; 359:7-13. [DOI: 10.1016/j.ijcard.2022.04.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/05/2022] [Accepted: 04/11/2022] [Indexed: 11/29/2022]
|
24
|
Mahalwar G, Shariff M, Datla S, Agrawal A, Rathore SS, Arif TB, Iqbal K, Hussain N, Majmundar M, Kumar A, Kalra A. Meta-analysis of ProGlide Versus MANTA Vascular Closure Devices For Large-Bore Access Site Management. Indian Heart J 2022; 74:251-255. [PMID: 35367458 PMCID: PMC9243605 DOI: 10.1016/j.ihj.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 03/04/2022] [Accepted: 03/11/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Gauranga Mahalwar
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH, USA
| | | | | | | | - Sawai Singh Rathore
- Department of Internal Medicine, Dr. Sampurnanand Medical College, Jodhpur, Rajasthan, India
| | - Taha Bin Arif
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Kinza Iqbal
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Nabeel Hussain
- Saba University School of Medicine, The Bottom, the Netherlands
| | - Monil Majmundar
- Department of Cardiology, Maimonides Medical Center, Brooklyn, NYC, NY, USA
| | - Ashish Kumar
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH, USA
| | - Ankur Kalra
- Division of Cardiovascular Medicine, Krannert Cardiovascular Research Center, Indiana University School of Medicine, Indianapolis, IN, USA.
| |
Collapse
|
25
|
Masiero G, D'Angelo L, Fovino LN, Fabris T, Cardaioli F, Rodinò G, Benedetti A, Boiago M, Continisio S, Montonati C, Sciarretta T, Zuccarelli V, Scotti A, Lorenzoni G, Pavei A, Napodano M, Fraccaro C, Iliceto S, Marchese A, Esposito G, Tarantini G. Real-World Experience With a Large Bore Vascular Closure Device During TAVI Procedure: Features and Predictors of Access-Site Vascular Complications. Front Cardiovasc Med 2022; 9:832242. [PMID: 35295263 PMCID: PMC8919188 DOI: 10.3389/fcvm.2022.832242] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 01/14/2022] [Indexed: 12/19/2022] Open
Abstract
Backgrounds Among vascular closure devices (VCDs), the novel collagen plug-based MANTA VCD is the first designed for large bore percutaneous access. We aimed to assess the features and predictors of access-site vascular complications in an unselected trans-femoral transcatheter aortic valve replacement (TF-TAVR) population. Methods Patients undergoing large bore arteriotomy closure with 18F MANTA VCD following TF-TAVR at a large tertiary care center from September 2019 to January 2021 were prospectively analyzed. Primary Outcome was the MANTA VCD access-site-related complications according to Valve Academic Research Consortium-3 (VARC) definitions. Its incidence and predictors were evaluated. Results Eighty-eight patients (median age 82 years, 48% male, 3.3 median Society of Thoracic Surgeons score) undergoing TF-TAVR were included, mostly (63%) treated with a self-expandable device and with outer diameter sizes varied from 18F to 24-F. MANTA VCD technical success rate was 98%, while 10 patients (11%) experienced MANTA VCD access-site vascular complications which included 8% of minor complications and only to 2% of major events resulting in VARC type ≥2 bleeding. Vessel occlusion/stenosis (60%), perforation (20%), and pseudoaneurysm/dissection/hematoma (20%) occurred, but all were managed without surgical treatment. Independent predictors of failure were age (p = 0.04), minimum common femoral artery diameter (CFA) (p < 0.01), sheath-to-femoral-artery ratio (SFAR) (p < 0.01), and a lower puncture height (p = 0.03). A CFA diameter <7.1 mm with a SFAR threshold of 1.01 were associated with VCD failure. Conclusions In a more comers TF-TAVR population, MANTA VCD was associated with reassuring rates of technical success and major access-site vascular complications. Avoiding lower vessel size and less puncture site distance to CFA bifurcation might further improve outcomes.
Collapse
Affiliation(s)
- Giulia Masiero
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Livio D'Angelo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Luca Nai Fovino
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Tommaso Fabris
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Francesco Cardaioli
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Giulio Rodinò
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Alice Benedetti
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Mauro Boiago
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Saverio Continisio
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Carolina Montonati
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Tommaso Sciarretta
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Vittorio Zuccarelli
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Andrea Scotti
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Giulia Lorenzoni
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Andrea Pavei
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Massimo Napodano
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Chiara Fraccaro
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Sabino Iliceto
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Alfredo Marchese
- Unit of Cardiology, GVM Care and Research, Anthea Hospital, Bari, Italy
| | - Giovanni Esposito
- Divisions of Cardiology and Cardiothoracic Surgery, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
- *Correspondence: Giuseppe Tarantini
| |
Collapse
|
26
|
Marcusohn E, Qasum M, Epstein D, Solomonica A, Orbach A, Musallam A, Kerner A, Feld Y. Vascular Complications Among Patients Undergoing Trans-femoral Transcatheter Aortic Valve Implantation: Prostar vs ProGlide Parallel Technique. Angiology 2022; 73:635-642. [PMID: 35147041 DOI: 10.1177/00033197211058498] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Reliable femoral artery closure devices are essential for the success of trans-femoral Transcatheter Aortic Valve Implantation (TAVI) procedures. Accordingly, device choice might affect vascular complications and bleeding rates. This was a retrospective analysis, comparing vascular complication rates among patients who underwent trans-femoral TAVI with vascular access closure using either the ProGlide parallel suture or Prostar closure devices. We included 191 patients: 106 were treated with Prostar and 85 with ProGlide. The ProGlide group had higher rate of diabetes, chronic kidney disease, peripheral arterial disease, and significantly smaller femoral arteries that were treated via larger sheaths. Valve Academic Research Consortium (VARC)-2 major complications were similar between the groups. (4.7% for ProGlide vs 3.8% for Prostar, P=1), with similar incidence of closure device failure (2 vs 3, P=1). No differences were found after univariant analysis and propensity-score matching in the incidence of major and minor bleeding nor in the rate of in-hospital mortality between ProGlide and Prostar (4.7 vs 2.8%, P=.7, 1.2 vs 2.8%, P=.63, and 1.2 vs .0%, P=.45, respectively). Parallel suture technique using two ProGlide sutures showed comparable rates of vascular complications to the Prostar closure device in higher risk population of TAVI patients.
Collapse
Affiliation(s)
- Erez Marcusohn
- Department of Cardiology, Rambam Health Care Campus, Haifa, Israel
| | - Majd Qasum
- Department of Cardiology, Rambam Health Care Campus, Haifa, Israel
| | - Danny Epstein
- Critical Care Division, Rambam Health Care Campus, Haifa, Israel
| | - Amir Solomonica
- Department of Cardiology, Rambam Health Care Campus, Haifa, Israel.,Rappaport - Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Ady Orbach
- Schulich Heart Center - Sunnybrook Health Science Center, Toronto, ON, Canada
| | - Anees Musallam
- Department of Cardiology, Rambam Health Care Campus, Haifa, Israel
| | - Arthur Kerner
- Department of Cardiology, Rambam Health Care Campus, Haifa, Israel.,Rappaport - Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Yair Feld
- Department of Cardiology, Rambam Health Care Campus, Haifa, Israel.,Rappaport - Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| |
Collapse
|
27
|
Miyashita H, Moriyama N, Laine M. Incidence and Predictors of Access Site Vascular Complications Following Ultrasound-Guided MANTA Closure Deployment. J Endovasc Ther 2021; 29:576-585. [PMID: 34852659 PMCID: PMC9270567 DOI: 10.1177/15266028211059446] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Purpose: There is no report on the reproducibility of the ultrasound-navigated MANTA
deployment (US-MANTA) technique and little is known about predictors for
US-MANTA-related vascular complication (VC). This study aimed to assess the
incidence and predictors of access-site VC using the US-MANTA technique and
report insights of MANTA-related VC from consecutive cases following
large-bore arteriotomy. Materials and Methods: Consecutive patients who underwent transfemoral transcatheter aortic valve
replacement with the US-MANTA technique from November 2018 to February 2020
were evaluated. MANTA-related VC was defined as access-site complications
leading to major or minor VCs based on Valve Academic Research Consortium-2
criteria. Results: Among 378 patients, 23 cases (6.1%) of MANTA-related VC (major VC: n=7
[1.9%], minor VC: n=16 [4.2%]) were identified. No significant difference
was observed in the incidence of MANTA-related VC over the observational
period (first quartile: 5.3%, second: 5.4%, third: 7.4%, and fourth: 6.3%,
p>.50). In 7 patients with MANTA-related major VC, 4 (57.1%) of
complications resulted from incomplete apposition of the toggle due to
anterior wall calcification of the common femoral artery (CFA). Anterior
calcification of the CFA determined by computed tomography was identified as
an independent predictor of MANTA-related VCs. Conclusions: The US-MANTA technique sustainably provides a low rate of access-site VCs
following large-bore arteriotomy. Incomplete apposition of the toggle due to
anterior calcification of the CFA may lead to ongoing vascular and bleeding
complications.
Collapse
Affiliation(s)
- Hirokazu Miyashita
- Department of Cardiology, Heart and
Lung Center, Helsinki University and Helsinki University Central Hospital, Helsinki,
Finland
- Department of Cardiology and
Catheterization Laboratories, Shonan Kamakura General Hospital, Kamakura,
Japan
| | - Noriaki Moriyama
- Department of Cardiology and
Catheterization Laboratories, Shonan Kamakura General Hospital, Kamakura,
Japan
| | - Mika Laine
- Department of Cardiology, Heart and
Lung Center, Helsinki University and Helsinki University Central Hospital, Helsinki,
Finland
- Mika Laine, Adjunctive Professor,
Department of Cardiology, Heart and Lung Center, Helsinki University and
Helsinki University Central Hospital, Haartmaninkatu 4, Helsinki 00290, Finland.
| |
Collapse
|
28
|
Berti S, Bartorelli AL, Koni E, Giordano A, Petronio AS, Iadanza A, Bedogni F, Reimers B, Spaccarotella C, Trani C, Attisano T, Sardella G, Bonmassari R, Medda M, Sherwood MW, Tomai F, Navarese EP. Impact of High Body Mass Index on Vascular and Bleeding Complications After Transcatheter Aortic Valve Implantation. Am J Cardiol 2021; 155:86-95. [PMID: 34284861 DOI: 10.1016/j.amjcard.2021.06.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/09/2021] [Accepted: 06/14/2021] [Indexed: 12/20/2022]
Abstract
Increased body mass index (BMI) is an established cardiovascular risk factor. The impact of high BMI on vascular and bleeding complications in patients undergoing transcatheter aortic valve implantation (TAVI) is not clarified. RISPEVA, a multicenter prospective database of patients undergoing TAVI stratified by BMI was used for this analysis. Patients were classified as normal or high BMI (obese and overweight) according to the World Health Organization criteria. A comparison of 30-day vascular and bleeding outcomes between groups was performed using propensity scores methods. A total of 3776 matched subjects for their baseline characteristics were included. Compared with normal BMI, high BMI patients had significantly 30-day greater risk of the composite of vascular or bleeding complications (11.1% vs 8.8%, OR: 1.28, 95% CI [1.02 to 1.61]; p = 0.03). Complications rates were higher in both obese (11.3%) and overweight (10.5%), as compared with normal weight patients (8.8%). By a landmark event analysis, the effect of high versus normal BMI on these complications appeared more pronounced within 7 days after the TAVI procedure. A significant linear association between increased BMI and vascular complications was observed at this time frame (p = 0.03). In conclusion, compared with normal BMI, both obese and overweight patients undergoing TAVI, experience increased rates of 30-day vascular and bleeding complications. These findings indicate that high BMI is an independent risk predictor of vascular and bleeding complications after TAVI.
Collapse
Affiliation(s)
- Sergio Berti
- Department of Diagnostic and Interventional Cardiology, Gabriele Monasterio Tuscany Foundation, G. Pasquinucci Heart Hospital, Massa, Italy
| | - Antonio L Bartorelli
- Centro Monzino, IRCCS and Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - Endrin Koni
- Department of Diagnostic and Interventional Cardiology, Gabriele Monasterio Tuscany Foundation, G. Pasquinucci Heart Hospital, Massa, Italy; Department of Interventional Cardiology, Santa Corona Hospital, Pietra Ligure, Italy
| | - Arturo Giordano
- Unità Operativa di Interventistica Cardiovascolare, Pineta Grande Hospital, Castel Volturno, Italy
| | - Anna S Petronio
- Department of Cardiology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Alessandro Iadanza
- Azienda Ospedaliera Universitaria Senese, Policlinico Le Scotte, Siena, Italy
| | - Francesco Bedogni
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, Milan, Italy
| | - Bernard Reimers
- Cardio Center, Humanitas Research Hospital IRCCS, Rozzano-Milan, Italy
| | - Carmen Spaccarotella
- Division of Cardiology, CCU and Interventional, Cardiology, Cardiovascular Research Center, University Magna Graecia, Catanzaro, Italy
| | - Carlo Trani
- Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Tiziana Attisano
- Department of Cardiology, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy
| | - Gennaro Sardella
- Department of Cardiology, Policlinico "Umberto I," Sapienza University of Rome, Rome, Italy
| | | | - Massimo Medda
- Istituto Clinico Sant'Ambrogio, Gruppo San Donato, Milano, Italy
| | | | | | - Eliano P Navarese
- Interventional Cardiology and Cardiovascular Medicine Research, Department of Cardiology and Internal Medicine, Nicolaus Copernicus University, Bydgoszcz, Poland; Faculty of Medicine, University of Alberta, Edmonton, Canada.
| |
Collapse
|
29
|
Dumpies O, Kitamura M, Majunke N, Hartung P, Haag A, Wilde J, Desch S, Sandri M, Crusius L, Noack T, Kiefer P, Leontyev S, Borger M, Thiele H, Holzhey D, Abdel-Wahab M. Manta versus Perclose ProGlide vascular closure device after transcatheter aortic valve implantation: Initial experience from a large European center. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 37:34-40. [PMID: 34257057 DOI: 10.1016/j.carrev.2021.06.134] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 06/02/2021] [Accepted: 06/30/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Vascular and bleeding complications are common after transcatheter aortic valve implantation (TAVI) and are associated with worse outcomes. The plug-based Manta (M) vascular closure device (VCD) is a novel option to achieve haemostasis for large-bore arterial access sites. OBJECTIVE We aimed to compare vascular and bleeding complications between the M-VCD and the established suture-based Perclose ProGlide (P)-VCD. METHODS From February to September 2019 a total of 578 patients underwent transfemoral TAVI at a single high-volume centre. Access site closure was performed using M-VCD in 195 patients (33.7%) and P-VCD in 383 patients (66.3%). We assessed vascular and access site-related complications as well as bleeding events according to the Valve Academic Research Consortium-2 definition. RESULTS Overall vascular complications occurred less frequently in the M-VCD group (10.7% vs. 19.0%, p = 0.011) driven by a significantly lower rate of major vascular events (2.0% vs. 6.5%, p = 0.025). Access site-related complications were significantly less frequent in the M-VCD cohort (10.7% vs. 16.6%, p = 0.048). The M-VCD was associated with significantly lower rates of major (0.5% vs. 4.4%, p = 0.009) and life-threatening bleeding (0% vs. 2.3%, p = 0.032). In multivariable analysis, the use of M-VCD was the only independent predictor of vascular complications (odds ratio 0.54, 95% confidence interval 0.32-0.91, p = 0.022). CONCLUSIONS The M-VCD was associated with a reduction of vascular and access-site complications as well as severe bleeding after transfemoral TAVI compared to the P-VCD in this observational study.
Collapse
Affiliation(s)
- Oliver Dumpies
- Department of Structural Heart Disease/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Mitsunobu Kitamura
- Department of Structural Heart Disease/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Nicolas Majunke
- Department of Structural Heart Disease/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Phillip Hartung
- Department of Structural Heart Disease/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Anna Haag
- Department of Structural Heart Disease/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Johannes Wilde
- Department of Structural Heart Disease/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Steffen Desch
- Department of Structural Heart Disease/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Marcus Sandri
- Department of Structural Heart Disease/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Lisa Crusius
- Department of Structural Heart Disease/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Thilo Noack
- Department of Structural Heart Disease/Cardiac Surgery, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Philipp Kiefer
- Department of Structural Heart Disease/Cardiac Surgery, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Sergey Leontyev
- Department of Structural Heart Disease/Cardiac Surgery, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Michael Borger
- Department of Structural Heart Disease/Cardiac Surgery, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Holger Thiele
- Department of Structural Heart Disease/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - David Holzhey
- Department of Structural Heart Disease/Cardiac Surgery, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Mohamed Abdel-Wahab
- Department of Structural Heart Disease/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany.
| |
Collapse
|
30
|
Medranda GA, Case BC, Zhang C, Rappaport H, Weissman G, Bernardo NL, Satler LF, Ben-Dor I, Rogers T, Waksman R. Propensity-matched comparison of large-bore access closure in transcatheter aortic valve replacement using MANTA versus Perclose: A real-world experience. Catheter Cardiovasc Interv 2021; 98:580-585. [PMID: 34051039 DOI: 10.1002/ccd.29786] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/05/2021] [Accepted: 05/09/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Compare two large-bore vascular closure devices (VCDs), collagen-plug-based MANTA and suture-based dual Perclose ProGlide (PP), in patients undergoing contemporary transfemoral transcatheter aortic valve replacement (TAVR). BACKGROUND The SAFE MANTA IDE clinical trial demonstrated that the collagen-plug-based MANTA VCDs were safe and effective in closing large-bore arteriotomies. However, data comparing this collagen-plug-based VCD to the suture-based VCD in contemporary practice are sparse. METHODS This was a retrospective observational study in which we screened transfemoral (TF) TAVR patients at our institution from 2017 to 2020. Included were those whose large-bore TF access was closed using either MANTA or PP with and without Angio-Seal. Our primary outcome was VCD success. Additional in-hospital outcomes included major and minor vascular complications, post-TAVR length of stay, and mortality. RESULTS We screened 696 patients who underwent TAVR. Using propensity scores, we matched 124 patients who received MANTA with 124 patients who received PP. Patients had a mean age of 77.2 years, 69.0% were men, and their mean Society of Thoracic Surgeons score was 3.4%. VCD success was equivalent between VCDs (95.2% vs. 95.2%; p = 1.000). Patients had similar rates of mortality (0% vs. 0.8%; p = .316), and no patients had major vascular complications. CONCLUSIONS In contemporary TAVR, the collagen-plug-based MANTA VCD appears to be as safe and effective as the suture-based dual PP VCD, with no differences in VCD success, vascular complications, or mortality. Therefore, selection of VCD for TAVR should be left to operator discretion, taking into account anatomical considerations.
Collapse
Affiliation(s)
- Giorgio A Medranda
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Brian C Case
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Cheng Zhang
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Hank Rappaport
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Gaby Weissman
- Department of Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Nelson L Bernardo
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Lowell F Satler
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Itsik Ben-Dor
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Toby Rogers
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA.,Cardiovascular Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| |
Collapse
|
31
|
Theivacumar NS, Qureshi MI, Glasgow S, Najem M. Pledget reinforcement and traction compression as adjunctive techniques for suture-based closure of arterial cannulation sites in percutaneous endovascular aneurysm repair—initial experience. J Vasc Surg Cases Innov Tech 2021; 7:183-187. [PMID: 33748559 PMCID: PMC7973132 DOI: 10.1016/j.jvscit.2020.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 12/21/2020] [Indexed: 11/16/2022] Open
Abstract
Suture-based vascular closure devices are used in percutaneous endovascular procedures. However, failures are not uncommon. We have described our initial experience with two adjunct techniques to reinforce the suture-based vascular closure device (ProGlide; Abbot Vascular, Santa Clara, Calif) after percutaneous endovascular aneurysm repair. The threads of the ProGlide device (Abbot Vascular) were passed through a pledget with the help of a needle, which was secured to the puncture site to allow for traction compression. The use of the techniques can be helpful if the suture-based vascular closure devices fail to achieve immediate and complete hemostasis. The use of these adjuncts could reduce the incidence of closure-related complications after percutaneous endovascular procedures.
Collapse
Affiliation(s)
- Nadarajah Selva Theivacumar
- Correspondence: Nadarajah Selva Theivacumar, MBBS, MD, FRCS, West London Vascular and Interventional Centre, Northwick Park Hospital, Watford Rd, Harrow HA1 3UJ, United Kingdom
| | | | | | | |
Collapse
|
32
|
Frequency, impact and predictors of access complications with plug-based large-bore arteriotomy closure - A patient level meta-analysis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 34:69-74. [PMID: 33612412 DOI: 10.1016/j.carrev.2021.02.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/01/2021] [Accepted: 02/11/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND/PURPOSE The MANTA is a dedicated plug-based large-bore vascular closure device (VCD) providing safe hemostasis in most patients, but data on the clinical impact and mechanisms of MANTA related complications are limited. This study sought to determine the frequency, impact and predictors of MANTA-related access complications. METHODS/MATERIALS This patient-level meta-analysis included data from 2 medical device approval studies and 1 post-approval registry. The primary endpoint was the composite of major and minor access complications. Technical success was defined as hemostasis with MANTA closure device without need for vascular surgery or stenting. RESULTS Eight hundred ninety-one patients (mean age 80) underwent transcatheter aortic valve replacement (n = 814), endovascular aortic repair (n = 71), balloon aortic valvuloplasty (n = 4) or mechanical circulatory support (n = 2). Technical success was 96.4% and median time to hemostasis was 31 (interquartile range: 17-76) seconds. The primary endpoint occurred 9.1% and bailout vascular surgery or stenting was necessary in 32 patients (3.6%). Female gender (OR: 2.63, CI: 1.46-4.73, p = 0.001), left femoral access (OR: 2.18, CI: 1.17-4.06, p = 0.015) and unfavorable arteriotomy phenotype (combination of a small femoral artery diameter with a deep arteriotomy; OR 2.27: 1.26-4.10, p = 0.006) independently predicted access complications. Access complications most often consisted of vessel dissection, stenosis or occlusion and predominantly occurred in patients with an unfavorable arteriotomy phenotype. CONCLUSIONS Large-bore arteriotomy closure with MANTA VCD provided fast and safe hemostasis with an acceptable complication rate. Refined procedure planning and risk-stratification may further improve MANTA VCD performance. STUDY SUMMARY This study of 891 patients undergoing percutaneous interventions with large-bore arteriotomies showed that the MANTA closure device provides safe and rapid hemostasis in >95%. Independent predictors of MANTA failure were female gender, left femoral access and unfavorable arteriotomy phenotype (i.e. combination of a small femoral artery diameter with a deep arteriotomy). Patients exhibiting the latter were especially at risk for vessel dissection, stenosis or closure.
Collapse
|
33
|
Wiechen MP, Kroon H, Hokken TW, Ooms JF, Ronde‐Tillmans MJ, Daemen J, Jaegere PP, Van Mieghem NM. Vascular complications with a plug‐based vascular closure device after transcatheter aortic valve replacement: Predictors and bail‐outs. Catheter Cardiovasc Interv 2021; 98:E737-E745. [PMID: 33533544 PMCID: PMC9292646 DOI: 10.1002/ccd.29506] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 11/18/2020] [Accepted: 12/06/2020] [Indexed: 12/17/2022]
Abstract
Background The MANTA vascular closure device (VCD) is dedicated to large bore access closure and associated with favorable results in selected study populations. Anatomical predictors for access site complications are lacking. Aim To evaluate MANTA in a real‐world population and identify predictors for vascular complications. Methods All patients undergoing transfemoral transcatheter aortic valve replacement (TAVR) between January 2016 and May 2020 with MANTA closure were included. Baseline characteristics were collected, pre‐procedural computed tomography and post‐deployment femoral angiograms were analyzed for anatomical differences. The primary endpoint was a composite of access site related major and minor vascular complications at 30 days follow‐up according to the VARC‐2 definitions. Secondary endpoints included bleeding, time to hemostasis, procedural length and incomplete arteriotomy closure or arterial occlusion by angiography. A Cox proportional hazards model was used to compare all‐cause mortality for patients with and without an access site complication. Results The 512 patients underwent TAVR with MANTA access closure. Median age was 80 (IQR 75–85), 53% was male, median BMI was 26.4 kg/m2 (IQR 23.4–29.7). Access site related major‐ or minor vascular complication occurred in 20 (4%) and 23 (4%) of patients respectively. Median time to hemostasis was 42 s (IQR 28–98). Post deployment angiogram showed an occlusion in 24 patients (5%), incomplete closure in 60 patients (12%) or both in three patients (1%). Of these 87 patients, 36 (41%) had a vascular complication. Femoral artery diameter (OR 0.70 [0.53–0.93]), low‐ (OR 3.47 [1.21–10.00]) and high (OR 2.43 [1.16–5.10]) arteriotomies were independent predictors for vascular complications. Conclusion In this contemporary TAVR population, access‐site related complications occurred in 8% of patients and were mainly due to percutaneous closure device failure. Small artery diameter and off‐target punctures were independent predictors.
Collapse
Affiliation(s)
- Maarten P. Wiechen
- Department of Cardiology Erasmus University Medical Center Rotterdam Netherlands
| | - Herbert Kroon
- Department of Cardiology Erasmus University Medical Center Rotterdam Netherlands
| | - Thijmen W. Hokken
- Department of Cardiology Erasmus University Medical Center Rotterdam Netherlands
| | - Joris F. Ooms
- Department of Cardiology Erasmus University Medical Center Rotterdam Netherlands
| | | | - Joost Daemen
- Department of Cardiology Erasmus University Medical Center Rotterdam Netherlands
| | - Peter P. Jaegere
- Department of Cardiology Erasmus University Medical Center Rotterdam Netherlands
| | | |
Collapse
|
34
|
Reifart J, Liebetrau C, Weferling M, Dörr O, Renker M, Bhumimuang K, Liakopoulos O, Choi YH, Nef H, Hamm CW, Kim WK. Single versus double use of a suture-based closure device for transfemoral aortic valve implantation. Int J Cardiol 2021; 331:183-188. [PMID: 33529662 DOI: 10.1016/j.ijcard.2021.01.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/11/2021] [Accepted: 01/22/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND The most common method of percutaneous closure in transfemoral transcatheter aortic valve implantation (TAVI) employs two obtusely oriented ProGlide devices. The aim of this study was to assess the feasibility and safety of using a single ProGlide system for primary access site closure in comparison with the double ProGlide approach in an all-comers TAVI population. METHODS Between March 2016 and December 2018, a total of 1105 patients underwent transfemoral TAVI for severe aortic stenosis at our center. Application of two ProGlide systems was standard until April 2017 (n = 432), whereas thereafter a single ProGlide system was used (n = 663). A 1:1 propensity score matching was performed to adjust for baseline differences between the two groups, resulting in 327 matched cases. Primary outcomes of interest were main access site-related vascular complications. RESULTS The mean number of ProGlide devices used per patient was 1.03 (SD 0.2) in the single-ProGlide group versus 2.01 (SD 0.14) in the double-ProGlide group. An additional vascular closure device was required to obtain full hemostasis in 23.2% versus 9.5% of patients (p < 0.001) in the two groups, respectively. Technical success of ProGlide usage was similar (94.3% versus 92.1%, p = 0.163). In the matched cohorts, the rates of main access site-related major vascular complications were similar (4.0% vs. 6.4%, p = 0.217). CONCLUSION The single-ProGlide technique is feasible, with rates of technical success similar to those of the double-ProGlide technique. Use of this method did not lead to more frequent access site-related complications but was more cost effective than the double-ProGlide approach.
Collapse
Affiliation(s)
- Joerg Reifart
- Kerckhoff Heart Center, Department of Cardiology, Bad Nauheim, Germany; DZHK (German Center for Cardiovascular Research), Partner Site RheinMain, Frankfurt am Main, Germany.
| | - Christoph Liebetrau
- Kerckhoff Heart Center, Department of Cardiology, Bad Nauheim, Germany; DZHK (German Center for Cardiovascular Research), Partner Site RheinMain, Frankfurt am Main, Germany
| | - Maren Weferling
- Kerckhoff Heart Center, Department of Cardiology, Bad Nauheim, Germany; DZHK (German Center for Cardiovascular Research), Partner Site RheinMain, Frankfurt am Main, Germany
| | - Oliver Dörr
- Justus-Liebig University of Giessen, Department of Cardiology, Giessen, Germany
| | - Matthias Renker
- Kerckhoff Heart Center, Department of Cardiology, Bad Nauheim, Germany; DZHK (German Center for Cardiovascular Research), Partner Site RheinMain, Frankfurt am Main, Germany
| | - Kid Bhumimuang
- Kerckhoff Heart Center, Department of Cardiology, Bad Nauheim, Germany
| | - Oliver Liakopoulos
- Kerckhoff Heart Center, Department of Cardiac Surgery, Bad Nauheim, Germany
| | - Yeong-Hoon Choi
- Kerckhoff Heart Center, Department of Cardiac Surgery, Bad Nauheim, Germany
| | - Holger Nef
- Justus-Liebig University of Giessen, Department of Cardiology, Giessen, Germany
| | - Christian W Hamm
- Kerckhoff Heart Center, Department of Cardiology, Bad Nauheim, Germany; DZHK (German Center for Cardiovascular Research), Partner Site RheinMain, Frankfurt am Main, Germany; Justus-Liebig University of Giessen, Department of Cardiology, Giessen, Germany
| | - Won-Keun Kim
- Kerckhoff Heart Center, Department of Cardiology, Bad Nauheim, Germany; DZHK (German Center for Cardiovascular Research), Partner Site RheinMain, Frankfurt am Main, Germany; Kerckhoff Heart Center, Department of Cardiac Surgery, Bad Nauheim, Germany; Justus-Liebig University of Giessen, Department of Cardiology, Giessen, Germany
| |
Collapse
|
35
|
Najem M, Martin G, Patrone L, Malina M, Theivacumar NS. Pledget Reinforcement and Tractional Compression as Adjunctive Techniques for Suture-Mediated Closure (SMC) in Percutaneous Endovascular Aneurysm Repair (pEVAR): A Retrospective Observational Cohort Study. Ann Vasc Surg 2021; 73:369-374. [PMID: 33444773 DOI: 10.1016/j.avsg.2020.11.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 11/08/2020] [Accepted: 11/11/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Percutaneous endovascular aneurysm repair (pEVAR) is commonly utilized and requires the use of suture-mediated closure (SMC) devices to ensure adequate femoral artery hemostasis. Despite the use of such devices, puncture-related complications remain relatively common. We introduced two new adjuncts (pledget reinforcement and tractional compression) along with SMC to reduce such puncture-related complications. The aim of the study was to assess the efficacy and safety of the new adjunct techniques. METHODS This retrospective observational cohort study examines the impact of two adjunctive techniques on puncture-related complications compared with the previous year data before this new introduction of adjunct techniques. RESULTS Sixty-one percutaneous femoral punctures (in 31 patients) utilizing adjunct techniques for closure (the adjunct group) were retrospectively compared with 89 punctures (in 46 patients) closed with standard SMC technique (the standard group). The use of adjunctive techniques led to a significant reduction in overall puncture-related complications (3/61 (4.9%) vs. 20/89 (22.5%), P = 0.0106) and the need for emergent surgical repair after failed hemostasis (2/61 (3.3%) vs. 13/89 (14.6%), P = 0.037). CONCLUSIONS These novel adjunctive techniques (pledget reinforcement and tractional compression) of SMC for pEVAR reduce puncture-related complications and increase the confidence to offer percutaneous techniques for more patients.
Collapse
Affiliation(s)
- Mojahid Najem
- West London Vascular & Interventional Centre (WeLVIC), Northwick Park Hospital, Harrow, UK
| | - Guy Martin
- West London Vascular & Interventional Centre (WeLVIC), Northwick Park Hospital, Harrow, UK
| | - Lorenzo Patrone
- West London Vascular & Interventional Centre (WeLVIC), Northwick Park Hospital, Harrow, UK
| | - Martin Malina
- West London Vascular & Interventional Centre (WeLVIC), Northwick Park Hospital, Harrow, UK
| | - Nada Selva Theivacumar
- West London Vascular & Interventional Centre (WeLVIC), Northwick Park Hospital, Harrow, UK
| |
Collapse
|
36
|
Case BC, Yerasi C, Forrestal BJ, Kumar S, Musallam A, Chezar-Azerrad C, Khalid N, Shlofmitz E, Khan JM, Satler LF, Ben-Dor I, Rogers T, Waksman R. Real-World Experience of the MANTA Closure Device: Insights From the FDA Manufacturer and User Facility Device Experience (MAUDE) Database. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 27:63-66. [PMID: 33402323 DOI: 10.1016/j.carrev.2020.11.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 11/18/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND/PURPOSE The MANTA vascular closure device (VCD) is the first commercially available dedicated closure device for large-bore femoral arterial access-site closure and was approved by the United States Food and Drug Administration (FDA) in February 2019. Real-world data on the most commonly reported complications and modes of failure associated with the MANTA closure device are limited. We analyzed post-marketing surveillance data from FDA's Manufacturer and User Facility Device Experience (MAUDE) database for the MANTA VCD (Teleflex, Wayne, Pennsylvania). METHODS/MATERIALS Post-marketing surveillance data from the FDA MAUDE database from February 2019 through March 2020 were analyzed, yielding 170 reports. RESULTS Of the 170 reports of major complications involving MANTA devices, 141 reports involved either injury (136) or death (5) related to the device. Of the 141 reports, bleeding was the most common adverse outcome described (45), followed by vessel occlusion (30) and vessel dissection (21). Device malfunction incidents (29 reports) were reported in 4 main categories: failed deployment (16 reports), malposition of the collagen (9), insufficient information (3), and device dislocation (1). CONCLUSIONS Our analysis of the MAUDE database demonstrates that in real-world practice, the MANTA VCD was found to be associated with complications, including death, vascular injury, and difficulties with the device itself. Ongoing user education, proctoring, and pre-procedural patient selection are important to minimize risks associated with the MANTA VCD.
Collapse
Affiliation(s)
- Brian C Case
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Charan Yerasi
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Brian J Forrestal
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Sant Kumar
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Anees Musallam
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Chava Chezar-Azerrad
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Nauman Khalid
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Evan Shlofmitz
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Jaffar M Khan
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America; Cardiovascular Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, United States of America
| | - Lowell F Satler
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Itsik Ben-Dor
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Toby Rogers
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America; Cardiovascular Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, United States of America
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America.
| |
Collapse
|
37
|
van Wiechen MP, Tchétché D, Ooms JF, Hokken TW, Kroon H, Ziviello F, Ghattas A, Siddiqui S, Laperche C, Spitzer E, Daemen J, de Jaegere PP, Dumonteil N, Van Mieghem NM. Suture- or Plug-Based Large-Bore Arteriotomy Closure: A Pilot Randomized Controlled Trial. JACC Cardiovasc Interv 2020; 14:149-157. [PMID: 33358648 DOI: 10.1016/j.jcin.2020.09.052] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/23/2020] [Accepted: 09/29/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES This study sought to test the superiority in terms of efficacy and safety of a dedicated plug-based vascular closure device (VCD) during transcatheter aortic valve replacement (TAVR) over a suture-based VCD. BACKGROUND Vascular complications after TAVR are relevant and often associated with VCD failure. METHODS The MASH (MANTA vs. Suture-based vascular closure after transcatHeter aortic valve replacement) trial is an international, 2-center pilot randomized controlled trial comparing the MANTA VCD (Teleflex, Wayne, Pennsylvania) versus 2 ProGlides (Abbott Vascular, Abbott Park, Illinois). The primary composite endpoint consisted of access site-related major or minor vascular complications at 30-days' follow-up. Secondary endpoints included clinically relevant access site bleeding, time to hemostasis, and modified VCD failure (defined as failure to achieve hemostasis within 5 min or requiring additional endovascular maneuvers such as endovascular stenting, surgical techniques, or additional closure devices). Adverse events were adjudicated by an independent clinical events committee according to the VARC-2 definitions. RESULTS A total of 210 TAVR patients were included between October 2018 and January 2020. Median age was 81 years, 54% were male, and the median STS score was 2.7%. There was no significant difference in the primary endpoint of access site-related vascular complications between MANTA and ProGlide (10% vs. 4%; p = 0.16). Clinically significant access site bleedings were similar with both closure techniques (9% vs. 6%; p = 0.57). Modified VCD failure occurred less frequently in MANTA versus ProGlide (20% vs. 40%; p < 0.01). Suture-based closure required more often additional closure devices, whereas MANTA numerically needed more covered stents and surgical bailouts. CONCLUSIONS Plug-based large-bore arteriotomy closure was not superior to suture-based closure. Plug-based closure required fewer, but a different kind of bailout maneuvers.
Collapse
Affiliation(s)
- Maarten P van Wiechen
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Didier Tchétché
- Department of Cardiology, Clinique Pasteur, Toulouse, France
| | - Joris F Ooms
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Thijmen W Hokken
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Herbert Kroon
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Francesca Ziviello
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Angie Ghattas
- Department of Cardiology, Clinique Pasteur, Toulouse, France
| | | | | | - Ernest Spitzer
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Joost Daemen
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Peter P de Jaegere
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Nicolas M Van Mieghem
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands.
| |
Collapse
|
38
|
Kroon HG, Tonino PAL, Savontaus M, Amoroso G, Laine M, Christiansen EH, Toggweiler S, Ten Berg J, Sathananthan J, Daemen J, de Jaegere PP, Brueren GBRG, Malmberg M, Slagboom T, Moriyama N, Terkelsen CJ, Moccetti F, Gheorghe L, Webb J, Wood D, Van Mieghem NM. Dedicated plug based closure for large bore access -The MARVEL prospective registry. Catheter Cardiovasc Interv 2020; 97:1270-1278. [PMID: 33347739 PMCID: PMC8246962 DOI: 10.1002/ccd.29439] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/24/2020] [Accepted: 11/29/2020] [Indexed: 12/17/2022]
Abstract
Objectives To study safety and performance of the MANTA Vascular closure device (VCD) under real world conditions in 10 centers. Background The MANTA is a novel plug‐based device for large bore arteriotomy closure. Methods We included all eligible patients who underwent transfemoral large bore percutaneous procedures. Exclusion criteria were per operator's discretion and included severe calcification or marked tortuosity of the access vessel, presence of marked obesity/cachexia or a systolic blood pressure above 180 mmHg. The primary performance endpoint was time to hemostasis. Primary and secondary safety endpoints were major and minor access site related vascular complications up to 30 days, respectively. Vascular complications were adjudicated by an independent clinical event committee according to VARC‐2 criteria. We performed multivariable logistic regression to estimate the effect of baseline and procedural characteristics on any and major vascular complications. Results Between February 2018 and July 2019 500 patients were enrolled undergoing Transcatheter aortic valve replacement (TAVR, N = 496), Balloon aortic valvuloplasty (BAV, N = 2), Mechanical circulatory support (MCS, N = 1) or Endovascular aneurysm repair (EVAR, N = 1). Mean age was 80.8 ± 6.6 years with a median STS‐score of 2.7 [IQR 2.0–4.3] %. MANTA access site complications were major in 20 (4%) and minor in 28 patients (5.6%). Median time to hemostasis was 50 [IQR 20–120] sec. Severe femoral artery calcification, scar presence in groin, longer procedure duration, female gender and history of hypertension were independent predictors for vascular complications. Conclusion In this study, MANTA appeared to be a safe and effective device for large bore access closure under real‐world conditions.
Collapse
Affiliation(s)
- Herbert G Kroon
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Pim A L Tonino
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
| | - Mikko Savontaus
- Department of Cardiology, Turku University Hospital, Turku, Finland
| | - Giovanni Amoroso
- Department of Cardiology, Onze Lieve Vrouwe Hospital, Amsterdam, The Netherlands
| | - Mika Laine
- Department of Cardiology, Helsinki University Hospital, Helsinki, Finland
| | | | | | - Jur Ten Berg
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Janarthanan Sathananthan
- Centre for Cardiovascular and Heart Valve Innovation, St. Paul's and Vancouver General Hospital, Vancouver, Canada
| | - Joost Daemen
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Peter P de Jaegere
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Guus B R G Brueren
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
| | - Markus Malmberg
- Department of Cardiology, Turku University Hospital, Turku, Finland
| | - Ton Slagboom
- Department of Cardiology, Onze Lieve Vrouwe Hospital, Amsterdam, The Netherlands
| | - Noriaki Moriyama
- Department of Cardiology, Helsinki University Hospital, Helsinki, Finland
| | | | | | - Livia Gheorghe
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - John Webb
- Centre for Cardiovascular and Heart Valve Innovation, St. Paul's and Vancouver General Hospital, Vancouver, Canada
| | - David Wood
- Centre for Cardiovascular and Heart Valve Innovation, St. Paul's and Vancouver General Hospital, Vancouver, Canada
| | - Nicolas M Van Mieghem
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
39
|
Shah A, Ghoreishi M, Taylor BS, Toursavadkohi S, Kaczorowski DJ. Complete percutaneous decannulation from femoral venoarterial extracorporeal membrane oxygenation. JTCVS Tech 2020; 6:75-81. [PMID: 34318149 PMCID: PMC8300481 DOI: 10.1016/j.xjtc.2020.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 11/12/2020] [Indexed: 11/25/2022] Open
Abstract
Objectives To evaluate the clinical outcomes and perioperative complications associated with complete percutaneous decannulation of femoral venoarterial extracorporeal membrane oxygenation (VA-ECMO) with the MANTA closure device. Methods This is a retrospective analysis of a single surgeon consecutive series of 14 patients at a single center who underwent decannulation from VA-ECMO, 10 of whom underwent a percutaneous method of femoral cannula removal. Results After a mean duration of VA-ECMO support of 7.4 ± 3.8 days, all 10 patients, with arterial cannulas ranging in size from 17 to 21 Fr, underwent percutaneous decannulation with the MANTA closure device, with immediate hemostasis. One patient had acute lower limb ischemia that was recognized intraoperatively and successfully treated with suction embolectomy. Two patients had a pseudoaneurysm at the distal perfusion catheter site recognized on perioperative imaging studies, one resolving with observation and the other necessitating thrombin injection. One patient had a hematoma that resolved with observation. Conclusions Percutaneous decannulation from VA-ECMO using the MANTA large-bore vascular closure device is feasible and results in immediate hemostasis with excellent angiographic results.
Collapse
Affiliation(s)
- Aakash Shah
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Md
| | - Mehrdad Ghoreishi
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Md
| | - Bradley S Taylor
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Md
| | - Shahab Toursavadkohi
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Md
| | - David J Kaczorowski
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Md
| | | |
Collapse
|
40
|
Vendrik J, Baan J. MANTA closure device shows promise in transfemoral transcatheter aortic valve replacement. Neth Heart J 2020; 28:637-638. [PMID: 33113102 PMCID: PMC7683669 DOI: 10.1007/s12471-020-01511-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2020] [Indexed: 12/19/2022] Open
Affiliation(s)
- J Vendrik
- Department of Cardiology, Heart Centre, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.
| | - J Baan
- Department of Cardiology, Heart Centre, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| |
Collapse
|
41
|
Berti S, Bedogni F, Giordano A, Petronio AS, Iadanza A, Bartorelli AL, Reimers B, Spaccarotella C, Trani C, Attisano T, Marella Cenname A, Sardella G, Bonmassari R, Medda M, Tomai F, Tarantini G, Navarese EP. Efficacy and Safety of ProGlide Versus Prostar XL Vascular Closure Devices in Transcatheter Aortic Valve Replacement: The RISPEVA Registry. J Am Heart Assoc 2020; 9:e018042. [PMID: 33103545 PMCID: PMC7763424 DOI: 10.1161/jaha.120.018042] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Transcatheter aortic valve replacement (TAVR) requires large‐bore access, which is associated with bleeding and vascular complications. ProGlide and Prostar XL are vascular closure devices widely used in clinical practice, but their comparative efficacy and safety in TAVR is a subject of debate, owing to conflicting results among published studies. We aimed to compare outcomes with Proglide versus Prostar XL vascular closure devices after TAVR. Methods and Results This large‐scale analysis was conducted using RISPEVA, a multicenter national prospective database of patients undergoing transfemoral TAVR treated with ProGlide versus Prostar XL vascular closure devices. Both multivariate and propensity score adjustments were performed. A total of 2583 patients were selected. Among them, 1361 received ProGlide and 1222 Prostar XL. The predefined primary end point was a composite of cardiovascular mortality, bleeding, and vascular complications assessed at 30 days and 1‐year follow‐up. At 30 days, there was a significantly greater reduction of the primary end point with ProGlide versus Prostar XL (13.8% versus 20.5%, respectively; multivariate adjusted odds ratio, 0.80 [95% CI, 0.65–0.99]; P=0.043), driven by a reduction of bleeding complications (9.1% versus 11.7%, respectively; multivariate adjusted odds ratio, 0.76 [95% CI, 0.58–0.98]; P=0.046). Propensity score analysis confirmed the significant reduction of major adverse cardiovascular events and bleeding risk with ProGlide. No significant differences in the primary end point were found between the 2 vascular closure devices at 1 year of follow‐up (multivariate adjusted hazard ratio, 0.88 [95% CI, 0.72–1.10]; P=0.902). Comparable results were obtained by propensity score analysis. During the procedure, compared with Prostar XL, ProGlide yielded significant higher device success (99.2% versus 97.5%, respectively; P=0.001). Conclusions ProGlide has superior efficacy as compared with Prostar XL in TAVR procedures and is associated with a greater reduction of composite adverse events at short‐term, driven by lower bleeding complications. Registration Information URL: clinicaltrials.gov; Unique identifier: NCT02713932.
Collapse
Affiliation(s)
- Sergio Berti
- Department of Diagnostic and Interventional Cardiology Gabriele Monasterio Tuscany Foundation, G. Pasquinucci Heart Hospital Massa Italy
| | - Francesco Bedogni
- Department of Clinical and Interventional Cardiology IRCCS Policlinico San Donato Milan Italy
| | - Arturo Giordano
- Unità Operativa di Interventistica Cardiovascolare Pineta Grande Hospital Castel Volturno Italy
| | - Anna S Petronio
- Department of Cardiology Azienda Ospedaliero-Universitaria Pisana Pisa Italy
| | - Alessandro Iadanza
- Azienda Ospedaliera Universitaria Senese, Policlinico Le Scotte Siena Italy
| | - Antonio L Bartorelli
- Centro Monzino IRCCS and Department of Biomedical and Clinical Sciences "Luigi Sacco" University of Milan Italy
| | - Bernard Reimers
- Cardio Center Humanitas Research Hospital IRCCS Rozzano-Milan Italy
| | - Carmen Spaccarotella
- Division of Cardiology CCU and Interventional Cardiology Cardiovascular Research Center University Magna Graecia Catanzaro Italy
| | - Carlo Trani
- Institute of Cardiology Fondazione Policlinico Universitario A. Gemelli IRCCS Università Cattolica del Sacro Cuore Rome Italy
| | - Tiziana Attisano
- Cardiologia Interventistica Dipartimento Cardio Toraco Vascolare AOU S. Giovanni di Dio e Ruggi D'Aragona Salerno Italt
| | - Angela Marella Cenname
- Fondazione Policlinico Universitario A. Gemelli IRCCS Università Cattolica del Sacro Cuore Rome Italy
| | - Gennaro Sardella
- Department of Cardiology Policlinico "Umberto I" Sapienza University of Rome Italy
| | | | - Massimo Medda
- Istituto Clinico Sant'Ambrogio, Gruppo San Donato Milano Italy
| | | | | | - Eliano P Navarese
- Department of Cardiology and Internal Medicine Interventional Cardiology and Cardiovascular Medicine Research Nicolaus Copernicus University Bydgoszcz Poland.,Faculty of Medicine University of Alberta Edmonton Canada.,SIRIO MEDICINE Research Network Bydgoszcz Poland
| | | |
Collapse
|
42
|
Morello A, Corcione N, Ferraro P, Cimmino M, Pepe M, Cassese M, Frati G, Biondi-Zoccai G, Giordano A. The best way to transcatheter aortic valve implantation: From standard to new approaches. Int J Cardiol 2020; 322:86-94. [PMID: 32814109 DOI: 10.1016/j.ijcard.2020.08.036] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/07/2020] [Accepted: 08/07/2020] [Indexed: 02/08/2023]
Abstract
Transcatheter aortic valve implantation (TAVI) is a safe and beneficial treatment for patients with severe symptomatic aortic stenosis at high and intermediate surgical risk. The safety of the procedure continues to improve thanks to more refined procedural approaches and devices but, also and above all, to the accrual of the procedural knowledge and expertise by the operators. The diversification of the approaches and the possibility to tailor the treatment on the individual needs and anatomical features of the patients allows a rapid learning curve in the management of even complications. Indeed, there are several approaches with which TAVI can be carried out: transfemoral arterial, subclavian, transcarotid, transaortic, transaxillary, transapical, and through right anterior thoracotomy. Although transfemoral venous TAVI is less common, it has already have been carried out using caval-aortic punctures. This field is rapidly evolving, and it will be of paramount importance for interventional cardiologists and cardiothoracic surgeons to keep up to date with further developments. This review intends to give an in-depth and update overview of both conventional and innovative TAVI approaches, with the scope to highlight the relevant advantages, major disadvantages, safety aspects and techniques.
Collapse
Affiliation(s)
- Alberto Morello
- Unità Operativa di Interventistica Cardiovascolare, Pineta Grande Hospital, Castel Volturno, Italy.
| | - Nicola Corcione
- Unità Operativa di Interventistica Cardiovascolare, Pineta Grande Hospital, Castel Volturno, Italy
| | - Paolo Ferraro
- Unità Operativa di Emodinamica, Santa Lucia Hospital, San Giuseppe Vesuviano, Italy
| | - Michele Cimmino
- Unità Operativa di Emodinamica, Santa Lucia Hospital, San Giuseppe Vesuviano, Italy
| | - Martino Pepe
- Division of Cardiology, Department of Emergency and OrganTransplantation, University of Bari, Bari, Italy
| | - Mauro Cassese
- Heart Surgery Department, Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Giacomo Frati
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; IRCCS NEUROMED, Pozzilli, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Mediterranea Cardiocentro, Naples, Italy
| | - Arturo Giordano
- Unità Operativa di Interventistica Cardiovascolare, Pineta Grande Hospital, Castel Volturno, Italy
| |
Collapse
|
43
|
Danenberg HD. Pay Attention on the Road: TAVR and Vascular Complications. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:1074-1075. [PMID: 32732149 DOI: 10.1016/j.carrev.2020.06.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 06/30/2020] [Indexed: 11/19/2022]
|
44
|
Assessment of the MANTA closure device in transfemoral transcatheter aortic valve replacement: a single-centre observational study. Neth Heart J 2020; 28:639-644. [PMID: 32720122 PMCID: PMC7683762 DOI: 10.1007/s12471-020-01465-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Objectives The present study aims to evaluate the efficacy and safety of the MANTA vascular closure device (VCD) (Teleflex, Morrisville, NC, USA) in transfemoral transcatheter aortic valve replacement (TF-TAVR). Background To close the femoral artery in TF-TAVR a VCD is the treatment of choice. Data involving suture-based VCDs have been extensive. Although scarce, results on the MANTA device are promising. There is no consensus yet as to whether the MANTA device is associated with fewer access-site-related vascular/bleeding complications when compared to suture-based VCDs. Methods In this prospective single-arm study, performed at a single centre, a total of 73 patients eligible for TF-TAVR were included and consecutively treated with the MANTA device. Results Access-site-related vascular complications were seen in 13.7% of patients treated with the MANTA device. In this group of patients only minor vascular complications were observed. Access-site-related bleeding complications were rare (6.8%), and device failure was seen in 13.7% of the patients. Conclusions This single-centre study confirms that use of the MANTA device in TF-TAVR is feasible with an acceptable rate of access-site-related complications and no major vascular complications.
Collapse
|
45
|
Lee CH, Ko YG, Park Y, Shim CY, Hong GR, Lee SH, Lee S, Jung HW, Hong SJ, Ahn CM, Kim JS, Kim BK, Choi D, Hong MK, Jang Y. Risk Factors for Closure Failure following Percutaneous Transfemoral Transcatheter Aortic Valve Implantation. Ann Vasc Surg 2020; 66:406-414. [DOI: 10.1016/j.avsg.2019.12.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 09/01/2019] [Accepted: 12/19/2019] [Indexed: 12/17/2022]
|
46
|
Kastengren M, Svenarud P, Källner G, Settergren M, Franco-Cereceda A, Dalén M. Percutaneous Vascular Closure Device in Minimally Invasive Mitral Valve Surgery. Ann Thorac Surg 2020; 110:85-91. [DOI: 10.1016/j.athoracsur.2019.10.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 09/30/2019] [Accepted: 10/14/2019] [Indexed: 12/20/2022]
|
47
|
Bemtgen X, Heidt T, Zotzmann V, Rilinger J, Wengenmayer T, Biever PM, von zur Mühlen C, Benk C, Bode C, Staudacher DL. Venoarterial extracorporeal membrane oxygenation decannulation using the novel Manta vascular closure device. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2020; 9:342-347. [DOI: 10.1177/2048872620918707] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Aims: Removal of large calibre arterial sheaths, as employed in venoarterial extracorporeal membrane oxygenation, is still associated with a high risk for vascular access site complications. In this study, we investigated the large bore Manta closure device as an option for venoarterial extracorporeal membrane oxygenation decannulation. Methods and results: Sixteen patients weaned from venoarterial extracorporeal membrane oxygenation between January–June 2019 were prospectively included in a registry (eight during extracorporeal cardiopulmonary resuscitation, seven with severe cardiogenic shock and one patient with fulminant pulmonary embolism). All patients had an arterial sheath removed at bedside using the Manta device achieving rapid haemostasis without clinically relevant complications afterwards. A computed tomography angiography was available for 11 patients (68.8%) and reassessed with regards to relevant pathologies at the closure device. Average intraluminal area was 40.4 mm2 (12.2–76.3 mm2) at the closure site. All devices but one were correctly deployed. Three patients (27.3%) had a visible thrombus at the closure device resulting in a >60% stenosis, two of which had a puncture site distal of the femoral artery bifurcation. Conclusion: Decannulation from venoarterial extracorporeal membrane oxygenation using the Manta closure device is a viable approach for rapid haemostasis, but is also associated with a significant risk of thrombotic vessel stenosis. These preliminary findings indicate that puncture in near proximity or distal to the femoral bifurcation might identify patients at risk and further studies are needed.
Collapse
Affiliation(s)
- Xavier Bemtgen
- Department of Cardiology and Angiology I, University Heart Center Freiburg – Bad Krozingen - University of Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Germany
| | - Timo Heidt
- Department of Cardiology and Angiology I, University Heart Center Freiburg – Bad Krozingen - University of Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Germany
| | - Viviane Zotzmann
- Department of Cardiology and Angiology I, University Heart Center Freiburg – Bad Krozingen - University of Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Germany
| | - Jonathan Rilinger
- Department of Cardiology and Angiology I, University Heart Center Freiburg – Bad Krozingen - University of Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Germany
| | - Tobias Wengenmayer
- Department of Cardiology and Angiology I, University Heart Center Freiburg – Bad Krozingen - University of Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Germany
| | - Paul M Biever
- Department of Cardiology and Angiology I, University Heart Center Freiburg – Bad Krozingen - University of Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Germany
| | - Constantin von zur Mühlen
- Department of Cardiology and Angiology I, University Heart Center Freiburg – Bad Krozingen - University of Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Germany
| | - Christoph Benk
- Faculty of Medicine, University of Freiburg, Germany
- Department of Cardiovascular Surgery, University Heart Center Freiburg – Bad Krozingen - University of Freiburg, Germany
| | - Christoph Bode
- Department of Cardiology and Angiology I, University Heart Center Freiburg – Bad Krozingen - University of Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Germany
| | - Dawid L Staudacher
- Department of Cardiology and Angiology I, University Heart Center Freiburg – Bad Krozingen - University of Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Germany
| |
Collapse
|
48
|
Armstrong EJ, Kokkinidis DG. Vascular Closure Devices for Large-Bore Mechanical Circulatory Support Devices: Becoming MANT(d)Atory? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:879-881. [PMID: 32345537 DOI: 10.1016/j.carrev.2020.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 04/09/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Ehrin J Armstrong
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Denver, CO, USA.
| | - Damianos G Kokkinidis
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Denver, CO, USA
| |
Collapse
|
49
|
Vendrik J, Vlastra W, van Mourik MS, Delewi R, Beijk MA, Lemkes J, Wykrzykowska JJ, de Winter RJ, Henriques JS, Piek JJ, Vis MM, Koch KT, Baan J. Early mobilisation after transfemoral transcatheter aortic valve implantation: results of the MobiTAVI trial. Neth Heart J 2020; 28:240-248. [PMID: 32112292 PMCID: PMC7190768 DOI: 10.1007/s12471-020-01374-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background Immobilisation of patients after transfemoral transcatheter aortic valve implantation (TF-TAVI) is the standard of care, mostly to prevent vascular complications. However, immobilisation may increase post-operative complications such as delirium and infections. In this trial, we determine whether it is feasible and safe to implement early ambulation after TF-TAVI. Methods We prospectively included TF-TAVI patients from 2016 to 2018. Patients were assessed for eligibility using our strict safety protocol and were allocated (based on the time at which the procedure ended) to the EARLY or REGULAR group. Results A total of 150 patients (49%) were deemed eligible for early mobilisation, of which 73 were allocated to the EARLY group and 77 to the REGULAR group. The overall population had a mean age of 80 years, 48% were male with a Society of Thoracic Surgeons Predicted Risk of Mortality (STS-PROM) score of 3.8 ± 1.8. Time to mobilisation was 4 h 49 min ± 31 min in the EARLY group versus 20 h 7 min ± 3 h 6 min in the REGULAR group (p < 0.0001). There were no differences regarding the primary endpoint. No major vascular complications occurred and a similar incidence of minor vascular complications was seen in both groups (4/73 [5.5%] vs 6/77 [7.8%], p = 0.570). The incidence of the combined secondary endpoint was lower in the EARLY group (p = 0.034), with a numerically lower incidence for all individual outcomes (delirium, infections, pain and unplanned urinary catheter use). Conclusion Early mobilisation (ambulation 4–6 h post-procedure) of TF-TAVI patients is feasible and safe. Early ambulation decreases the combined incidence of delirium, infections, pain and unplanned urinary catheter use, and its adoption into contemporary TAVI practice may therefore be beneficial. Electronic supplementary material The online version of this article (10.1007/s12471-020-01374-5) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- J Vendrik
- Heart Centre, Amsterdam University Medical Centres (location AMC), Amsterdam, The Netherlands.
| | - W Vlastra
- Heart Centre, Amsterdam University Medical Centres (location AMC), Amsterdam, The Netherlands
| | - M S van Mourik
- Heart Centre, Amsterdam University Medical Centres (location AMC), Amsterdam, The Netherlands
| | - R Delewi
- Heart Centre, Amsterdam University Medical Centres (location AMC), Amsterdam, The Netherlands
| | - M A Beijk
- Heart Centre, Amsterdam University Medical Centres (location AMC), Amsterdam, The Netherlands
| | - J Lemkes
- Heart Centre, Amsterdam University Medical Centres (location VUMC), Amsterdam, The Netherlands
| | - J J Wykrzykowska
- Heart Centre, Amsterdam University Medical Centres (location AMC), Amsterdam, The Netherlands
| | - R J de Winter
- Heart Centre, Amsterdam University Medical Centres (location AMC), Amsterdam, The Netherlands
| | - J S Henriques
- Heart Centre, Amsterdam University Medical Centres (location AMC), Amsterdam, The Netherlands
| | - J J Piek
- Heart Centre, Amsterdam University Medical Centres (location AMC), Amsterdam, The Netherlands
| | - M M Vis
- Heart Centre, Amsterdam University Medical Centres (location AMC), Amsterdam, The Netherlands
| | - K T Koch
- Heart Centre, Amsterdam University Medical Centres (location AMC), Amsterdam, The Netherlands
| | - J Baan
- Heart Centre, Amsterdam University Medical Centres (location AMC), Amsterdam, The Netherlands
| |
Collapse
|
50
|
Pasrija C, Bernstein DA, Rice M, Tran D, Morales D, Grintz T, Deatrick KB, Gammie JS, Madathil R, Kaczorowski DJ. Sutureless Closure of Arterial Cannulation Sites. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2020; 15:138-141. [PMID: 32107959 DOI: 10.1177/1556984519899940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Percutaneous femoral cannulation for venoarterial extracorporeal membrane oxygenation (ECMO) is commonly performed but percutaneous removal of arterial cannulas has not been broadly accepted. We hypothesized that a system that allows endovascular access to ECMO circuits along with the MANTA® large-bore vascular closure device could be used to successfully close arterial ECMO cannulation sites in a large animal model. METHODS Yorkshire swine (40 to 60 kg, n = 2) were used for this study. In the first swine, the infrarenal abdominal aorta was exposed. The aorta was cannulated once using a 15 Fr cannula and twice with a 19 Fr arterial cannula. A novel adaptor system that facilitates endovascular access to ECMO circuits was connected, and a 0.035″ Benston wire was placed through the adaptor and guided into the aorta. The cannula was removed over the wire and manual pressure was applied. The MANTA® sheath was inserted over the wire followed by the closure unit and was deployed. The process was repeated at 2 separate sites. A similar experiment was performed in a second swine, but through a median sternotomy to cannulate the ascending aorta. RESULTS Good hemostasis was achieved at all cannulation sites. Angiography demonstrated unobstructed flow across all closure sites with no evidence of extravasation. CONCLUSIONS The data presented here support the use of the MANTA® vascular closure device for the closure of arterial cannulation sites following ECMO decannulation and demonstrates utility of a novel adaptor system for establishing endovascular access in this context.
Collapse
Affiliation(s)
- Chetan Pasrija
- 12264 Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Daniel A Bernstein
- 12264 Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Maryjoe Rice
- 12264 Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Douglas Tran
- 12264 Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - David Morales
- 12264 Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Kristopher B Deatrick
- 12264 Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - James S Gammie
- 12264 Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ronson Madathil
- 12264 Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - David J Kaczorowski
- 12264 Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| |
Collapse
|