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Published on: May 26, 2023
Comparative Effectiveness of Vascular Closure Device Strategies in Transcatheter Aortic Valve Replacement: A Network
Yifan Deng1, Yingjie Feng1, Shenghu He2
1Department of Cardiology, Northern Jiangsu People's Hospital, Yangzhou, China; Medical College of Yangzhou University, Yangzhou, China.
Background:
Transcatheter aortic valve replacement (TAVR) has become the preferred treatment for high-risk patients with severe aortic stenosis. However, the management of vascular complications associated with large-bore femoral arterial access sheaths remains challenging for clinicians. Traditional manual compression exhibits limited efficacy in homeostasis, while the clinical outcomes of vascular closure devices (VCDs) remain controversial. To conduct a systematic evaluation on the differences among various types of VCDs in preventing vascular complications and achieving device success rates post-TAVR.
Methods:
Systematic searches were conducted in PubMed, Web of Science, and Cochrane for clinical studies on VCD application post-TAVR. Two independent researchers performed study selection, data extraction, and quality assessment. A network meta-analysis (NMA) was conducted using STATA 16.0; device ranking was assessed via surface under the cumulative ranking curve (SUCRA).
Results:
A total of 28 studies (21,029 patients, 7 types of VCD) were included. NMA revealed FemoSeal-ProGlide was associated with lower risks of major vascular complications (odds ratio (OR) = 0.28, 95% confidence interval (CI): 0.09-0.86) and major bleeding events (OR = 0.20, 95% CI: 0.06-0.63). Prostar demonstrated a higher risk of nonmajor vascular complications (OR = 1.61, 95% CI: 1.14-2.29). AngioSeal-ProGlide showed the lowest device failure rate (OR = 0.21, 95% CI: 0.10-0.48). No significant differences were observed among other closure methods. SUCRA rankings indicated FemoSeal-ProGlide demonstrated best efficacy in reducing major vascular complications (89.7%), 30-day mortality (94.5%), and major bleeding events (75.4%). AngioSeal-ProGlide demonstrated best efficacy in minimizing nonmajor vascular complications (80.8%) and device failure (89.6%).
Conclusion:
Based on current evidence, the combined use of small-bore collagen plug-based and suture-mediated VCDs may represent the safest and most effective strategy for TAVR-related vascular closure. However, its clinical applicability requires further validation through large-scale randomized controlled trials.
