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Combination of Suture-Plug Vascular Closure Devices Versus Suture-Only Devices Following Transcatheter Aortic Valve
Saddik Haddad1,2, George Bashour1,2, Mamas A Mamas3
1Faculty of Medicine, Tishreen University, Latakia, Syria.
Background:
Transcatheter aortic valve implantation (TAVI) is an effective and safe intervention for severe symptomatic aortic stenosis regardless of surgical risk. Vascular complications following TAVI are considered among the most common and serious complications, with a higher risk of mortality.
Aims:
We aimed to perform a systematic review and meta-analysis to evaluate the safety and efficacy of the combination of suture-collagen plug vascular closure devices (VCDs) compared with suture-only devices.
Methods:
We have systematically searched the literature from inception until January 4, 2025, for cohort studies and clinical trials comparing the combination of suture-collagen plug vascular closure devices (VCDs) versus suture-only VCDs.
Results:
A total of 2064 patients across six studies were included in the analysis. All studies compared dual Perclose ProGlide versus 1 Perclose ProGlide + 1 Angio-Seal, except one study that used either one Prostar or dual ProGlide in the suture group. The combination group of suture-plug VCDs was associated with a statistically significant reduction of VCDs failure (RR = 0.14, CI 95% [0.09-0.23], p < 0.0001, I2 = 58.6938%), bleeding complications (RR = 0.35, CI95% [0.24-0.53], p < 0.0001, 0.0%), major vascular complications (RR = 0.42, CI 95% [0.28, 0.63], p < 0.0001, I2 = 50.4%), and minor vascular complications (RR = 0.54, CI 95% [0.43, 0.66], p < 0.0001, I2 = 0%). On the other hand, all-cause mortality did not have a statistically significant difference between the two groups (RR = 0.54, CI 95% [0.28, 1.05], p = 0.0709, I2 = 0%).
Conclusions:
In patients undergoing TAVI, the combination strategy of suture-plug VCDs is superior to suture-only devices regarding major and minor vascular complications, bleeding complications, and VCD failure. The significantly higher VCD failure of the suture-only group observed in our study led to the use of additional closure devices to secure hemostasis, raising concerns about a higher risk of peripheral ischemia.
