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Purse-string suture and 3-way stopcock for effective venous hemostasis in structural heart procedures: the SUTURE-3
Santiago Jesús Camacho Freire1,2, Miguel Ángel Montilla Garrido1, Elena Izaga Torralba1
1Servicio de Cardiología, Hospital Universitario Juan Ramón Jiménez, Huelva, España Servicio de Cardiología Hospital Universitario Juan Ramón Jiménez España Spain.
Insights
A new purse-string suture with a 3-way stopcock provides safe and effective venous hemostasis for structural heart procedures. This simplified technique achieved 100% success in closing large-bore venous access with minimal complications.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Surgery
Background:
- Secure venous access closure is critical after large-bore catheter procedures.
- Existing methods for venous hemostasis can be time-consuming and may have complications.
Purpose of the Study:
- To evaluate the safety and efficacy of a novel simplified purse-string suture with a 3-way stopcock for venous hemostasis.
- To assess this technique in patients undergoing structural heart procedures.
Main Methods:
- A multicenter, non-randomized prospective study included 222 patients with ≥ 10-Fr femoral venous access.
- The simplified purse-string suture with a 3-way stopcock was used for hemostasis.
- Safety was assessed per Valve Academic Research Consortium-3 criteria, alongside efficacy, pain scores (VAS), and 1-month follow-up.
Main Results:
- 100% hemostasis success rate was achieved instantaneously.
- Only 2 minor bleeding events (0.9%) were reported.
- No access complications, including infections, were observed at 1-month follow-up.
Conclusions:
- The simplified purse-string suture with a 3-way stopcock is a safe, effective, and simple method for venous hemostasis.
- This technique is well-suited for structural heart procedures requiring large-bore venous access.
Introduction And Objectives:
Complete and secure venous access closure is essential at the end of large-bore catheter-based procedures. The aim of this study is to evaluate the safety and efficacy profile of a new simplified purse-string suture with 3-way stopcock to improve venous hemostasis in structural heart procedures (the SUTURE-3 study).
Methods:
We conducted a multicenter, non-randomized and prospective study including all consecutive patients undergoing any interventional procedures with a ≥ 10-Fr femoral venous access in whom a simplified purse-string suture with 3-way stopcock for venous hemostasis was used. Exclusion criteria were < 10-Fr diameters or ipsilateral artery access. We evaluate the safety profile according to the Valve Academic Research Consortium-3 criteria, efficacy (correct hemostasis), a pain-score (visual analog scale [VAS]) and a clinical 1 month-follow up.
Results:
A total 222 patients were included. Mean age was 73.6 ± 9.7 years (58%, men; 85%, hypertensive; 44%, diabetics; 91%, had a past medical history of atrial fibrillation). We found significantly high CHA2DS2-VA (4.1 ± 1.8) and HAS-BLED (3.5 ± 1.6) scores with a higher proportion of previous major bleeding (62%). A total of 54% of patients were on oral anticoagulation and 25%/6% on single/dual antiplatelet therapy, respectively. The most common procedure was left atrial appendage closure (n = 154, 69%) and mitral valve transcatheter edge-to-edge repair (n = 41, 18%). Mean diameter access was 15.6 ± 5-Fr; 91%, echo-guided; compression time, 4 ± 1.7 h; pain in VAS, 0.6 ± 1.5. Hemostasis was instantaneous with a 100% success rate, and only 2 minor bleeding events being reported (0.9%). No access complications (including infections) were recorded after discharge at the 1-month follow-up.
Conclusions:
The simplified purse string suture with 3-way stopcock to improve venous hemostasis in structural heart procedures is a simple, inexpensive, safe and effective procedure.
