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Vascular Closure Devices versus Manual Compression in Cardiac Interventional Procedures: Systematic Review and
Naidong Pang1,2, Jia Gao1, Binghang Zhang2
1Department of Cardiology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China.
Insights
Vascular closure devices (VCDs) significantly reduce hemostasis time, enabling earlier patient ambulation and discharge after cardiac procedures compared to manual compression (MC). VCDs also improve patient satisfaction without increasing vascular complications.
Area of Science:
- Cardiology
- Vascular Surgery
- Interventional Procedures
Background:
- Manual compression (MC) and vascular closure devices (VCDs) are used for hemostasis after cardiac interventions.
- Controversy exists regarding the optimal method, with a need for systematic analysis.
Purpose of the Study:
- To systematically compare the efficacy, safety, and patient satisfaction of VCDs versus MC for vascular access site hemostasis.
- To provide a comprehensive meta-analysis to resolve controversies in the field.
Main Methods:
- Systematic search of PubMed, EMbase, Cochrane Library, and Web of Science for comparative studies up to April 2022.
- Meta-analysis of 32 studies (33,481 patients) assessing hemostasis time, ambulation, discharge, complication rates, and patient satisfaction.
- Heterogeneity and publication bias were evaluated using standard statistical methods.
Main Results:
- VCDs significantly shortened time to hemostasis, ambulation, and discharge (p < 0.00001).
- VCDs were associated with higher patient satisfaction (p = 0.002) and potentially lower major complication risk (p = 0.0001), though this was not supported by RCTs alone (p = 0.68).
- No significant differences were found in total or bleeding-related complication rates between VCDs and MC.
Conclusions:
- Vascular closure devices offer significant advantages over manual compression, including faster hemostasis, earlier ambulation, and discharge.
- VCDs enhance patient satisfaction and may lead to cost savings without increasing vascular complication risks.
- The findings support the broader adoption of VCDs in cardiac interventional procedures.
Backgrounds:
Manual compression (MC) and vascular closure device (VCD) are two methods of vascular access site hemostasis after cardiac interventional procedures. However, there is still controversial over the use of them and a lack of comprehensive and systematic meta-analysis on this issue.
Methods:
Original articles comparing VCD and MC in cardiac interventional procedures were searched in PubMed, EMbase, Cochrane Library, and Web of Science through April 2022. Efficacy, safety, patient satisfaction, and other parameters were assessed between two groups. Heterogeneity among studies was evaluated by I index and the Cochran Q test, respectively. Publication bias was assessed using the funnel plot and Egger's test.
Results:
A total of 32 studies were included after screening with inclusion and exclusion criteria (33481 patients). This meta-analysis found that VCD resulted in shorter time to hemostasis, ambulation, and discharge (p < 0.00001). In terms of vascular complication risks, VCD group might be associated with a lower risk of major complications (p = 0.0001), but the analysis limited to randomized controlled trials did not support this result (p = 0.68). There was no significant difference in total complication rates (p = 0.08) and bleeding-related complication rates (p = 0.05) between the two groups. Patient satisfaction was higher in VCD group (p = 0.002). Meta-regression analysis revealed no specific covariate as an influencing factor for above results (p > 0.05).
Conclusions:
Compared with MC, the use of VCDs significantly shortens the time of hemostasis and allows earlier ambulation and discharge, meanwhile without increase in vascular complications. In addition, use of VCDs achieves higher patient satisfaction and leads cost savings for patients and institutions.
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