Suture‐mediated arterial access site closure after transfemoral aortic valve implantation

Al–Rashid, Fadi; Plicht, Björn; Konorza, Thomas; Neumann, Till; Thielmann, Matthias; Wendt, Daniel; Erbel, Raimund; Eggebrecht, Holger

doi:10.1002/ccd.24326

Cited by 23 publications

(14 citation statements)

References 32 publications

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“…Besides manual compression or pneumatic compression devices (e.g., FemoStop), a technique of temporary subcutaneous "Figure-of-Eight" sutures is now frequently used to achieve hemostasis [10]. R€ uter et al [9] have recently investigated the concept of preclosure of the MitraClip venous access site using suture-mediated closure devices, a technique which is often used for arterial access management during transcatheter aortic valve implantation [11]. Using a single Proglide device, a single out of 72 (1.4%) patients, who also experienced failure of the closure device, required transfusion for postprocedural bleeding [9].…”

Section: Discussionmentioning

confidence: 99%

Risk and outcomes of complications during and after MitraClip implantation: Experience in 828 patients from the German TRAnscatheter mitral valve interventions (TRAMI) registry

Eggebrecht

Schelle

Puls³

et al. 2015

Cathet Cardio Intervent

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112

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Aims: To analyze risk and outcomes of complications during and after MitraClip implantation using multicenter data from the prospective German Transcatheter Mitral Valve Interventions (TRAMI) registry. Methods and Results: Data of 828 patients (mean age: 76.0 [71-81] years, 327 (40%) females) undergoing MitraClip implantation in Germany between 2010 and 2013 were analyzed. Most patients (85%) underwent elective procedures with on average implantation of 1.4 6 0.6 clips. Emergent cardiac surgery was not required; a single patient died intraoperatively. During the in-hospital period, complications occurred in 215 (25.9%) patients, of which 106 (12.8%) were considered major. Major bleeding complications were among the most frequent major complications (7.4%), while rates of pericardial tamponade (1.9%) and clip-specific complications (embolization: 0%, partial clip detachment: 1.9%) were low. In-hospital death, stroke or myocardial infarction (MACCE) occurred in 2.2, 0.9, and 0% patients, respectively. Patients with complications appeared to be older and more critically ill preinterventionally; in-hospital mortality was significantly higher as compared to those without procedural complications. Conclusions: MitraClip implantation appears to be a safe treatment option with low rates of MACCE and clip-specific complications. Catheterization and Cardiovascular Interventions 86: 728-735 (2015) Nevertheless, MitraClip therapy is not without complications. Careful patient selection and improvements in preventing peri-procedural bleeding have the potential of reducing post-procedural complications and improving outcomes. V C 2015 Wiley Periodicals, Inc.

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Section: Discussionmentioning

confidence: 99%

Risk and outcomes of complications during and after MitraClip implantation: Experience in 828 patients from the German TRAnscatheter mitral valve interventions (TRAMI) registry

Eggebrecht

Schelle

Puls³

et al. 2015

Cathet Cardio Intervent

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112

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“…TAVI was performed by a multidisciplinary heart-team in a hybrid operating room using standard techniques [15,16], predominantly under analgosedation [17], with percutaneous femoral artery access and closure [18]. One of two currently CE-approved bioprosthesis (Edwards Sapien [n = 155] and Medtronic CoreValve [n = 59]) was implanted.…”

Section: Methodsmentioning

confidence: 99%

Risk Assessment of Patients Undergoing Transfemoral Aortic Valve Implantation upon Admission for Post-Interventional Intensive Care and Surveillance: Implications on Short- and Midterm Outcomes

et al. 2016

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BackgroundSeveral studies have found that standard risk scores inaccurately reflect risk in TAVI cohorts. The assessment of mortality risk upon post-interventional ICU admission is important to optimizing clinical management. This study sought to determine outcomes and factors affecting mortality in patients admitted to the intensive care unit (ICU) after transcatheter aortic valve implantation (TAVI), and to analyze and compare the predictive values of SAPS II and EuroSCORE.Methods and Findings214 consecutive patients treated with transfemoral TAVI (2006–2012) admitted to the ICU in an academic tertiary-care university hospital, were included in this retrospective data analysis. The overall 30-day mortality rate was 7%. Non-survivors at 30-days and survivors showed differences in the rates of catecholamine therapy upon ICU admission (93 vs. 29%; p<0.001), stroke (20 vs. 1%;p<0.001), sepsis (27 vs. 2%;p<0.001), kidney injury (83 vs. 56%; log-rank p<0.001), catecholamine therapy (88 vs. 61%;log-rank p<0.001) and vascular complications (60 vs. 17%; p<0.001). Mean SAPS II score and predicted mortality were higher in non-survivors (38.1±7.0 vs. 29.9±6.2;p<0.001 and 23.1±11.7 vs. 10.5±8.2;p<0.001, retrospectively), whereas the logistic EuroSCORE could not discriminate between the groups (p = 0.555). Among the biochemical parameters, the maximum values of creatinine, procalcitonin, and troponin I during the first 48 h after ICU admission were significantly higher in non-survivors. Multivariate analysis of baseline characteristics and complications associated with two-year mortality showed no significant results.ConclusionsThe SAPS II is a good tool for estimating ICU mortality immediately after performing the TAVI procedure and provides valuable information for other known predictors of mortality.

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“…Should hemostasis fail, it is possible to implant a third (or even more) Proglide over the guidewire. Recently, Kahlert et al [38] reported a series of 94 TAVR patients in who preclosure of the arterial access site was accomplished with a single 6 Fr Proglide; an efficient hemostasis with cessation of any bleeding within 10 min offinal knot-tying was obtained in Review 83 out of the 94 patients with only one closure-failure with continuous bleeding despite prolonged manual compression requiring endovascular treatment.…”

Section: Closure Devicesmentioning

confidence: 97%

Interventions to reduce major vascular complications of TAVR

Barbanti

Webb

2013

Expert Review of Cardiovascular Therapy

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Suture‐mediated arterial access site closure after transfemoral aortic valve implantation

Cited by 23 publications

References 32 publications

Risk and outcomes of complications during and after MitraClip implantation: Experience in 828 patients from the German TRAnscatheter mitral valve interventions (TRAMI) registry

Risk and outcomes of complications during and after MitraClip implantation: Experience in 828 patients from the German TRAnscatheter mitral valve interventions (TRAMI) registry

Risk Assessment of Patients Undergoing Transfemoral Aortic Valve Implantation upon Admission for Post-Interventional Intensive Care and Surveillance: Implications on Short- and Midterm Outcomes

Interventions to reduce major vascular complications of TAVR

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