Percutaneous femoral access closure and prognosis following transcatheter aortic valve replacement: A systematic review and meta-analysis

Background: The impact of different percutaneous femoral access closure strategies on mortality and bleeding after transcatheter aortic valve replacement (TAVR) has been less studied. The aim of this study is to investigate whether different percutaneous femoral access closure strategies might affect systemic outcomes in patients undergoing TAVR. Methods: In this systematic review and meta-analysis, randomized trials comparing a suture-based closure (suture group) with a plug-based or suture/plug-based closure (control group) for hemostasis of the femoral access in patients undergoing TAVR were included. The primary endpoint of the study was all-cause death. Secondary endpoints included any bleeding (defined according Valve Academic Research Consortium (VARC) criteria) and unplanned endovascular or surgical repair at the access site. All endpoints were calculated at the longest available follow-up. Results: Four studies with a total of 1429 TAVR patients (suture-based group, n = 707; control group, n = 722) were available for quantitative synthesis. There was no statistically significant difference in all-cause death in patients who underwent TAVR with suture-based closure compared to the control group (risk ratio—RR = 1.04, 95% confidence interval—CI 0.60–1.82; p = 0.83). Similarly, there was no statistically significant difference between treatment groups for any bleeding and unplanned endovascular or surgical repair at the access site. However, there was a significant treatment effect for VARC bleeding type ⩾2 associated with the use of a plug-based or suture/plug-based closure in the control group ( p for interaction = 0.01). Conclusions: In the context of contemporary TAVR procedures, percutaneous closure of the femoral access using any suture or plug-based strategy has no impact on hard clinical outcomes such as death from any cause.