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A systematic algorithm for large-bore arterial access closure after TAVI: the TAVI-MultiCLOSE study.
Liesbeth Rosseel1,2, Nicholas J Montarello1, Philippe Nuyens1
1The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Summary
The MultiCLOSE algorithm offers safe and effective vascular closure after transfemoral transcatheter aortic valve implantation (TF-TAVI). This approach significantly reduces major vascular complications, improving patient outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Surgery
Background:
- Transcatheter aortic valve implantation (TAVI) is a standard procedure.
- Access site bleeding and vascular complications remain significant concerns, impacting patient morbidity and mortality.
Purpose of the Study:
- To evaluate the safety and efficacy of the novel MultiCLOSE vascular closure algorithm.
- To assess its performance in percutaneous large-bore arterial access closure following transfemoral TAVI (TF-TAVI).
Main Methods:
- Prospective, multicentre, observational study of TF-TAVI cases using the MultiCLOSE algorithm.
- A stepwise approach involving initial preclosure with suture-based vascular closure devices (VCDs), followed by sheath reinsertion for assessment and tailored final closure.
- Utilized either additional suture- or plug-based VCDs, or no further intervention.
Main Results:
- Complete arterial hemostasis achieved in 98% of 630 patients.
- Vascular closure device (VCD) failure occurred in 2% of patients, managed with balloon inflation, covered stent, or surgical repair.
- Low rates of minor (2.2%) and major (0.6%) vascular complications, with only 0.2% new minor complications at 30 days. In-hospital and 30-day all-cause mortality were 0.2% and 1.0%, respectively.
Conclusions:
- The MultiCLOSE algorithm provides an easy, safe, and effective method for vascular closure post-TF-TAVI.
- This algorithm results in durable vascular closure with a major complication rate below 1%.
