Large Bore Vascular Access Closure Device Strategies

Background: The optimal strategy for large bore vascular closure following TAVR is a matter of contention as major bleeding and vascular complications remain a challenge. We compared three strategies for post-TAVR vascular closure in terms of safety and efficacy: a dual ProGlide-based strategy, a hybrid strategy of ProGlide and Angio-Seal, and a MANTA strategy. Methods: Patients were enrolled in one of the three strategies: two ProGlides, a single ProGlide with an 8 F Angio-Seal, or a single 18 F MANTA. Results: In total, 172 patients were enrolled in this study: 86 in the MANTA group, 40 in the ProGlide/Angio-Seal group, 46 in the dual ProGlide group. Hemostasis was achieved in 95% of patients. MANTA was associated with vessel occlusion in 2% of cases. The dual ProGlide group required an extra device to achieve hemostasis in 35% of cases. Conclusion: The three strategies of MANTA, dual ProGlides, or ProGlide/Angio-Seal are all effective, but there are important differences between them which mandate careful consideration by operators.