Vascular Closure Devices for Large Bore Femoral Access After Transfemoral Transcatheter Aortic Valve Replacement: A Network Meta-Analysis
Corresponding Author
Sunil Upadhaya
Department of Internal Medicine, Section of Cardiology, Tulane University School of Medicine, New Orleans, Louisiana, USA
Correspondence: Sunil Upadhaya ([email protected]; [email protected])
Search for more papers by this authorAlina Upreti
Department of Biomedical Sciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
Search for more papers by this authorKunal Gupta
Department of Internal Medicine, Case Western Reserve University, Cleveland, Ohio, USA
Search for more papers by this authorBella Gonzalez-Perez
Department of Internal Medicine, Section of Cardiology, Tulane University School of Medicine, New Orleans, Louisiana, USA
Search for more papers by this authorRadia Ksayer
Department of Internal Medicine, Section of Cardiology, Tulane University School of Medicine, New Orleans, Louisiana, USA
Search for more papers by this authorPedro Cox-Alomar
Department of Medicine, Section of Cardiology, University of Miami, Miami, Florida, USA
Search for more papers by this authorCristina Sanina
Department of Internal Medicine, Section of Cardiology, Tulane University School of Medicine, New Orleans, Louisiana, USA
Search for more papers by this authorAnand Irimpen
Department of Internal Medicine, Case Western Reserve University, Cleveland, Ohio, USA
Search for more papers by this authorSerdar Farhan
Department of Medicine, Division of Cardiology, Lenox Hill Hospital, Northwell Health, New York, New York, USA
Search for more papers by this authorJose Wiley
Department of Internal Medicine, Section of Cardiology, Tulane University School of Medicine, New Orleans, Louisiana, USA
Search for more papers by this authorCorresponding Author
Sunil Upadhaya
Department of Internal Medicine, Section of Cardiology, Tulane University School of Medicine, New Orleans, Louisiana, USA
Correspondence: Sunil Upadhaya ([email protected]; [email protected])
Search for more papers by this authorAlina Upreti
Department of Biomedical Sciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
Search for more papers by this authorKunal Gupta
Department of Internal Medicine, Case Western Reserve University, Cleveland, Ohio, USA
Search for more papers by this authorBella Gonzalez-Perez
Department of Internal Medicine, Section of Cardiology, Tulane University School of Medicine, New Orleans, Louisiana, USA
Search for more papers by this authorRadia Ksayer
Department of Internal Medicine, Section of Cardiology, Tulane University School of Medicine, New Orleans, Louisiana, USA
Search for more papers by this authorPedro Cox-Alomar
Department of Medicine, Section of Cardiology, University of Miami, Miami, Florida, USA
Search for more papers by this authorCristina Sanina
Department of Internal Medicine, Section of Cardiology, Tulane University School of Medicine, New Orleans, Louisiana, USA
Search for more papers by this authorAnand Irimpen
Department of Internal Medicine, Case Western Reserve University, Cleveland, Ohio, USA
Search for more papers by this authorSerdar Farhan
Department of Medicine, Division of Cardiology, Lenox Hill Hospital, Northwell Health, New York, New York, USA
Search for more papers by this authorJose Wiley
Department of Internal Medicine, Section of Cardiology, Tulane University School of Medicine, New Orleans, Louisiana, USA
Search for more papers by this authorABSTRACT
Background and Aims
Large-bore femoral access is commonly required in transfemoral transcatheter aortic valve replacement (TF-TAVR), but vascular access complications remain prevalent, impacting patient outcomes. Various vascular closure devices (VCDs) are used for hemostasis, including the suture-based Prostar XL, Perclose ProGlide, and ProStyle, and the plug-based MANTA device. However, comprehensive comparative evidence on these VCDs, particularly single Perclose strategies, is lacking.
Methods
A systematic review and network meta-analysis were conducted according to PRISMA guidelines. We included randomized and observational studies comparing the safety and efficacy of VCDs for large-bore femoral access closure in TF-TAVR patients. Primary outcomes included major vascular complications; secondary outcomes included major and minor bleeding, minor vascular complications, VCD failure, and all-cause mortality. Frequentist and Bayesian analyses were performed using a random-effects model, with additional subgroup analyses of single Perclose strategies.
Results
Thirty-five studies comprising 16,503 patients met inclusion criteria. The single Perclose strategy, with or without adjunct Angio-Seal or FemoSeal, significantly reduced major vascular complications compared to dual Perclose (RR: 1.9, 95% CI [1.2−3.01]), MANTA (RR: 1.89, 95% CI [1.03−3.48]), and Prostar XL (RR: 3.46, 95% CI [1.94−6.18]). Among secondary outcomes, single Perclose also ranked highest in reducing minor complications and bleeding.
Conclusion
Single Perclose strategies, especially when combined with Angio-Seal, demonstrated superior safety and efficacy for large-bore femoral access closure following TF-TAVR. These findings support the need for further randomized trials to validate single Perclose as a primary approach in TF-TAVR vascular closure.
Conflicts of Interest
The authors declare no conflicts of interest.
Open Research
Data Availability Statement
Data derived from public domain resources.
Supporting Information
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