Simple option for large access vascular closure in case of failed suture-based closure device after TAVI

Introduction and objectives: Vascular complications remain a potential problem after transcatheter aortic valve implantation (TAVI). Although suture-based vascular closure devices are most often used for vascular closure purposes, alternative plug-based vascular closure devices like the MANTA (Essential Medical Inc., United States) stand as a bail-out option for patients with failed suture-based closure devices. Since knowing the exact vessel depth is essential to use this device correctly before inserting the large introducer, we aimed to validate 2 different measurement techniques including preoperative multidetector computer tomography (MDCT) plus an alternative technique with the Angio-Seal device (Terumo Medical Corporation, United States) compared to a vendor specific measuring tool. Methods: In patients eligible for TAVI, the depth of the femoral artery was measured preoperatively using MDCT, and then perioperatively with the Angio-Seal device. Both measurements were associated with the actual depth after puncture using the vendor-specific tool of the MANTA device. Results: In a total of 168 patients treated with transfemoral TAVI, the depth of the vessel was measured both pre and perioperatively. The measurements obtained from the preoperative MDCT revealed the existence of a moderate correlation compared to the preoperative measurements obtained (r = 0.64; P < .001). Measurements obtained with the Angio-Seal device revealed a high correlation with the measuring tool included (r = 0.99; P < .001). Overall, 10 patients required the bail-out option with the MANTA device due to failed suture-based vascular closure devices. Conclusions: In case of a failed suture-based vascular closure device after TAVI, the plug-based MANTA device can be used as a bail-out strategy. However, the measurement of the vessel depth obtained from preoperative MDCTs is not accurate enough for safe MANTA insertions. Measurements with the Angio-Seal device before inserting the large TAVI sheath stand as a simple solution to obtain exact measurements facilitating the use of the bail-out MANTA in case of failed suture-based closure vascular devices after TAVI.