With the increasing number of older patients, the number of TAVI procedures is also rising continuously. The vast majority of procedures are performed via the femoral artery. The biological heart valve is inserted into the body via this transfemoral access and carefully advanced to the aortic valve, where it is implanted. At the end of the procedure, once the heart valve has been successfully implanted, the access artery must be securely closed to prevent bleeding.
Vascular complications in the area of the access routes are common
Vascular complications in the area of the access routes are common. These complications range from haematomas and minor post-operative bleeding to severe, life-threatening bleeding and vascular injuries that may require further treatment or even surgery. Due to the fact that these complications prolong hospitalisation, affect recovery and are even prognostically significant, improving strategies to close access routes is of great importance for patient care.
The study compared two different closure techniques after TAVI. In the suture-based method, the vascular access is closed exclusively with two suture-based systems (ProGlideTM/ProStyleTM). The suture/plug method combines a suture-based system (ProGlideTM/ProStyleTM) with an additional plug-based closure system (Angio-Seal®). The study results show that the combined method enables faster haemostasis, shortens the duration of manual compression and reduces complication rates.
Combined method can significantly reduce complications
The ACCESS-TAVI study shows that the combined suture/plug method offers numerous advantages. For instance, vascular complications occurred in only 27 per cent of patients in the combined group, compared to 54 per cent of patients in the suture group. The time to complete haemostasis was also significantly shorter with the combined method. Relevant bleeding complications occurred in only 5.7 per cent of patients in the combination group, compared to 11.6 per cent in the suture group.
‘These results could revolutionise the standard for vascular closure after TAVI procedures,’ emphasises Dr Rheude. ‘Safe and reliable haemostasis not only means lower complication rates, but also a shorter hospital stay and therefore optimised patient care.
Video-Interview: Closure system strategies after TAVI (on herzmedizin.de)
Original publication:
Comparison of strategies for vascular ACCESS closure after Transcatheter Aortic Valve Implantation: the ACCESS-TAVI randomized trial. Rheude et al., European Heart Journal 2024
Contact:
Prof. Michael Joner, TUM University Hospital - German Heart Centre Munich, joner@dhm.mhn.de
