Retrograde aortic access for ventricular arrhythmia ablation: A novel plug and suture strategy for vascular closure

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  Figure 1. (1) Apply guide wires and introducers. Advance the suture-based vascular closure devices over the wire until the guide wire exit port aligns with the skin level. (2) Remove the guidewire, then advance the device further until artery blood is observed in the marker lumen. (3) Lift the lever to open the foot, stabilize the device at 45°, and depress the plunger by putting the right thumb on the handle and pulling with two fingers to deploy the needles. Cut the suture. (4) Lower the lever to close the foot. (5) Withdraw the device until the guidewire port is visible above the skin. Reintroduce the guide wire to maintain access and pull both suture limbs from the proximal guide. Remove device while keeping the guide wire in place. (6) Insert the steerable sheath and perform the ablation. (7) Load a snared knot pusher and advance the knot by applying slow consistent tension coaxial to the tissue tract. (8) Insert the guidewire and remove the procedure sheath. Advance until arterial blood flows from the drip hole in the locator. (9) Remove the arteriotomy locator and guidewire from the insertion sheath. Ensure that the tab on the reference indicator is in rear holding position and…