Preclosure of Large Bore Venous Access Sites in Patients Undergoing Transcatheter Mitral Replacement and Repair
Presenter
Mustafa Mohammed, Henry Ford Health System, Detroit, MI
Mustafa Mohammed1, Alejandro Lemor, M.D.1, Paul Nona, M.D.1, Brian o'Neill, MD1, Tiberio Frisoli, MD2, James Lee, M.D.1, William W. O'Neill, MD, MSCAI1, Dee Dee Wang, M.D., FSCAI3, Marvin H. Eng, M.D., FSCAI4 and Pedro Villablanca, MD1, (1)Henry Ford Health System, Detroit, MI, (2)Henry Ford Hospital, Detroit, MI, (3)Wayne State University School of Medicine, Detroit, MI, (4)Banner - University Medical Center Phoenix, Phoenix, AZ
Keywords: Complications, Structural Heart Disease (SHD) and Vascular Access, Management, and Closure
Background
Patients requiring transcatheter mitral valve repair (TMVr) and replacement (TMVR) interventions require large bore venous access (LBVA). Clinical outcome data on the use of suture-mediated devices for LBVA site closure are limited. We aim to report on the efficacy and safety of LBVA preclosure with PercloseTM (Abbott Vascular Devices, CA) suture-mediated device use following TMVr and TMVR. Methods
This is a retrospective cohort study in a large academic center. 354 consecutive high-risk patients with mitral valvular heart disease underwent TMVr (n=287) with MitraClip and TMVR (n=67) with Edwards Sapien Valves between 2012 and 2019. LBVA was required for those cases with the largest being 26 French sheath and smallest 16 French sheath. Complications were recorded and analyzed in those cases using and excel sheet. Results
All patients underwent preclosure of LBVA except for one that underwent manual hemostasis. There were no closure device failures. None of the cases required surgical repair of the access site following venous preclose. Two cases had large hematomas (>6 cm) following Perclose in each group. Six cases had small hematomas (<6cm and >2cm) with 3 in each group. There was one major bleeding using MVARC 2 definition (retroperitoneal bleed from arterial puncture) unrelated to the venous closure. Transfusion related to vascular access complication was required in 5 cases. There were 2 immediate acute deep venous thromboses post-procedure; one of which occurred after preclosure. There were no arteriovenous malformations, pseudoaneurysms or access site infections reported following Perclose. Conclusions
Proglide preclosure technique is a feasible and safe alternative approach to achieve hemostasis after removal of LBVA sheaths in patients undergoing TMVr and TMVR. Randomized trials are needed to compare suture-mediated versus other modalities of hemostasis.