One step forward or eight needles back: A retro(grade) approach to femoral hemostasis for TAVR

Percutaneous approach rather than surgical cutdown is the procedure of choice for TAVR patients to minimize morbidity and procedure time. ProGlide has been shown to have noninferior outcomes versus surgical cutdown with shorter procedure time and less pain; noninferiority was not demonstrated by single Prostar XL in a randomized trial of "preclosure" for endovascular aortic aneurysm repair. The current study did not include a ProGlide arm. As the size of Transcatheter Aortic Valve Replacement devices continues to decrease, the need for large bulky 4-needle devices like the Prostar XL is likely to become obsolete.