title: Suture-mediated arterial access site closure after transfemoral aortic valve implantation.
abstract: OBJECTIVE
  To evaluate feasibility, safety and efficacy of percutaneous arterial access site closure after transfemoral, transcatheter aortic valve implantation (TF-TAVI) using a single, commercially available six French monofilament suture-mediated vascular closure device (VCD) in "preclosure" technique.
  
  
  BACKGROUND
  Currently, TF-TAVI is evolving into a completely percutaneous procedure. However, percutaneous access site closure still remains a major technical challenge with room for improvement.
  
  
  METHODS
  94 of 144 consecutive patients underwent completely percutaneous TF-TAVI using following technique for access site closure: After puncture of the common femoral artery using fluoroscopy and contralateral angiography for guidance, the VCD was deployed prior further predilatation of the vessel and insertion of the large-bore introducer sheath. At the end of the procedure, the preloaded sutures were tied for final hemostasis and crossover angiography was used for postprocedural evaluation of the access vessel.
  
  
  RESULTS
  Application of the VCD was technically successful in all cases, resulting in an efficient hemostasis with cessation of any bleeding within 10 min of final knot-tying in 83 of the 94 patients, and there was only one closure-failure with continuous bleeding despite prolonged manual compression requiring endovascular treatment. In addition, we observed four closure-related access vessel stenoses of hemodynamic relevance requiring endovascular treatment in three and surgical repair in one patient. However, interventional and surgical repair was not associated with death or irreversible end-organ damage and all patients recovered without sequelae.
  
  
  CONCLUSIONS
  "Preclosure" of the arterial access site with a single six French suture-mediated VCD is relatively easy, safe and efficient method for access site closure after TF-TAVI which, along with ongoing profile reductions of TAVI devices, should further simplify and broaden the way toward a routine, completely percutaneous procedure.
authors.affiliation: Department of Cardiology, West-German Heart Center Essen, University Hospital Essen, University Duisburg-Essen, Germany. Philipp.Kahlert@uk-essen.de
authors.forename: Philipp
authors.initials: P
authors.lastname: Kahlert
authors.forename: Fadi
authors.initials: F
authors.lastname: Al-Rashid
authors.forename: Björn
authors.initials: B
authors.lastname: Plicht
authors.forename: Thomas
authors.initials: T
authors.lastname: Konorza
authors.forename: Till
authors.initials: T
authors.lastname: Neumann
authors.forename: Matthias
authors.initials: M
authors.lastname: Thielmann
authors.forename: Daniel
authors.initials: D
authors.lastname: Wendt
authors.forename: Raimund
authors.initials: R
authors.lastname: Erbel
authors.forename: Holger
authors.initials: H
authors.lastname: Eggebrecht
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000628:therapy*; D001157:Arterial Occlusive Diseases / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D006328:Cardiac Catheterization / Q000009:adverse effects; D016009:Chi-Square Distribution; D057510:Endovascular Procedures; D005240:Feasibility Studies; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D006439:Hemodynamics; D006470:Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D006489:Hemostatic Techniques / Q000009:adverse effects; D006801:Humans; D011677:Punctures; D015641:Radiography, Interventional; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013536:Suture Techniques / Q000009:adverse effects; D016896:Treatment Outcome