Combined suture and plug-based vascular closure devices reduced major vascular complications by 50% and device failure by 74% compared to dual suture devices in TAVR.
Does a combined suture and plug-based vascular closure device reduce vascular complications and bleeding compared to dual suture-based closure in patients undergoing transfemoral TAVR?
In patients undergoing transfemoral TAVR, a combined suture and plug-based vascular closure strategy significantly reduces major vascular complications and device failure compared to a dual suture-based approach.
Abstract Introduction Transcatheter Aortic Valve Replacement (TAVR) is the preferred treatment for severe aortic stenosis. However, vascular complications and bleeding remain common after transfemoral TAVR, impacting outcomes. While suture-based and plug-based vascular closure devices (VCDs) are used, a combined suture and plug-based approach may offer benefits. Purpose This study compares the effectiveness of dual suture-based arterial closure versus combined suture and plug-based closure in achieving hemostasis after TAVR. Methodology A systematic search of PubMed, Web of Science, and Embase was conducted until October 2024. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool for randomized controlled trials and the Newcastle-Ottawa Scale for cohort studies. Data analysis was performed using Review Manager version 5.4, with pooled outcomes reported as risk ratios or mean differences (MD) with 95% confidence intervals (CI). Results The meta-analysis included up to 2,304 patients across multiple studies. Major vascular bleeding (RR: 0.72, 95% CI: 0.39–1.34, p = 0.30) and minor vascular bleeding (RR: 0.86, 95% CI: 0.58–1.28, p = 0.47) showed no significant difference in the two groups. However, the suture plus plug-based vascular closure device significantly reduced major vascular complications by 50% (RR: 0.50, 95% CI: 0.33–0.76, p = 0.001) and minor vascular complications by 30% (RR: 0.70, 95% CI: 0.51–0.96, p = 0.03). VCD failure was 74% lower (RR: 0.26, 95% CI: 0.15–0.47, p 0.00001) in the suture plus plug-based group and unplanned interventions showed no significant difference (RR: 0.68, 95% CI: 0.38–1.22, p = 0.19) in this group. Conclusion The suture plus plug-based VCD demonstrated superiority over dual suture device by significantly reducing vascular complications and device failure incidents.
Volucke et al. (2025) studied this question. Combined suture and plug-based vascular closure devices reduced major vascular complications by 50% and device failure by 74% compared to dual suture devices in TAVR.
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