The Utilization of Single Vs.Double Perclose Devices For Preclosing Transfemoral Aortic Valve Replacement Access Site

Tuesday, May 21, 2019
Belmont Ballroom 2-3 (The Cosmopolitan of Las Vegas)
Najdat Bazarbashi, M.D. , Cleveland Clinic, cleveland, OH
Mohamed M Gad, MD , Cleveland Clinic, Cleveland, OH
Keerat R Ahuja, MD , Cleveland Clinic, Cleveland, OH
Antonette K Karrthik, MD , Cleveland Clinic, Cleveland, OH
Shameer Khubber, MD , Cleveland Clinic, Cleveland, OH
Manpreet Kaur, MD , Cleveland Clinic, Cleveland, OH
Yasser M Sammour, MD , Cleveland Clinic Foundation, Cleveland, OH
Amer Kadri, MD , Cleveland Clinic, Cleveland, OH
Stephanie L Mick, MD , Cleveland Clinic Foundation, Cleveland, OH
Grant W Reed, MD , Cleveland Clinic, Cleveland, OH
Jose L Navia, MD , Cleveland Clinic, Cleveland, OH
Rishi Puri, MD, PhD , Quebec Heart and Lung Institute
Amar Krishnaswamy, M.D. , Cleveland Clinic, Cleveland, OH
Samir Ramesh Kapadia, M.D., FSCAI , Cleveland Clinic, Cleveland, OH

Background
Percutaneous femoral access is used for majority of patients undergoing TAVR in US. Most centers use two 6F proglideTM devices for preclosing the access site. We have routinely used strategy of single proglide to preclose the access site for TAVR. In this retrospective analysis, we aim to compare vascular complications in patients who received a single Proglide Perclose versus those who received double devices for preclosure

Methods
Patients undergoing Transfemoral Aortic Valve Replacement (TF-TAVR) from January 2014 to December 2017 at the Cleveland Clinic underwent a retrospective review of medical charts and patients undergoing TF-TAVR. We included consecutive patients undergoing TF TAVR with Edward Sapien 3 valve. Vascular complications were defined according to the VARC-2 criteria

Results
A total of 740 patients were included in our current study, 487 patients (65.8%) received a single Perclose device while 253 patients (34.2%) received double Perclose devices for preclosure. The patients in both groups were older (mean age 80.96 +/- 9.04 vs. 80.60 +/- 9.06, p-value = 0.605, in the single and double Perclose groups respectively) white (94.7% vs. 94.5%, p-value = 0.890) males (57.9% vs. 60.5%, p-value = 0.501). Most of the baseline characteristics were not significantly different between both groups including Atrial Fibrillation (Afib), history of CABG or PCI, and history of stroke or TIA. The access sheath size was similar in both groups Vascular complications were similar with the use of single or double perclose strategy for preclosing. Of the total 487 patients with single perclose, 75.6% needed additional closure device (AngioSeal). With double perclose use for preclosure, additional closure device was needed less frequently (40.3%, p-value <0.005). Other vascular complication rates (hematoma, stenosis s/p ballon, stenosis s/p stent, and major vascular complications were similar between both groups

Conclusions
Single 6F proglide use for preclosure is safe for TF TAVR using S3 valve with no need for additional closure device in almost one quarter of the patients. When necessary, residual bleeding can be controlled with AngioSeal Device at the end of the procedure. This strategy can help to reduce cost for TAVR procedure

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