title: The adjunctive use of Angio-Seal in femoral vascular closure following percutaneous transcatheter aortic valve replacement.
abstract: OBJECTIVE
  The objective of this study was to describe and evaluate the adjunctive technique of Angio-Seal (AS) use to augment the dual Perclose ProGlide (PP) in achieving haemostasis in patients undergoing transfemoral percutaneous transcatheter aortic valve replacement (TAVR).
  
  
  RESULTS
  All patients who underwent TAVR from May 2007 to January 2015 via a planned transfemoral percutaneous approach with a dual PP pre-close strategy were retrospectively analysed. This cohort was divided into two groups: dual PP versus dual PP with adjunctive AS (PP+AS) use based on the specific status of intraprocedural haemostasis. The baseline and procedural characteristics and in-hospital outcomes were prospectively collected and retrospectively compared. Overall, a total of 387 consecutive patients (55% male, mean age 83 years) with dual PP (n=179) vs. dual PP+AS (n=208) were evaluated. There were no statistically significant differences between the dual PP vs. dual PP+AS groups with regard to the in-hospital Valve Academic Research Consortium-2 (VARC-2) primary endpoints of major vascular complications (8.0% vs. 6.6%, p=0.592), minor vascular complications (18.4% vs. 13.7%, p=0.218), life-threatening or disabling bleeding (5.1% vs. 3.0%, p=0.291), major bleeding (1.7% vs. 1.5%, p=1.000), and minor bleeding (14.4% vs. 10.6%, p=0.271).
  
  
  CONCLUSIONS
  The adjunctive Angio-Seal technique to augment the dual PP pre-close strategy for patients undergoing percutaneous femoral closure following TAVR is feasible and safe and may be considered as a bail-out or an alternative strategy when the dual PP closure technique fails to obtain complete haemostasis.
authors.affiliation: Section of Interventional Cardiology, MedStar Washington Hospital Center and MedStar Georgetown University Hospital, Washington, DC, USA.
authors.forename: Sarkis
authors.initials: S
authors.lastname: Kiramijyan
authors.forename: Marco A
authors.initials: MA
authors.lastname: Magalhaes
authors.forename: Itsik
authors.initials: I
authors.lastname: Ben-Dor
authors.forename: Edward
authors.initials: E
authors.lastname: Koifman
authors.forename: Ricardo O
authors.initials: RO
authors.lastname: Escarcega
authors.forename: Nevin C
authors.initials: NC
authors.lastname: Baker
authors.forename: Rebecca
authors.initials: R
authors.lastname: Torguson
authors.forename: Petros
authors.initials: P
authors.lastname: Okubagzi
authors.forename: Nelson L
authors.initials: NL
authors.lastname: Bernardo
authors.forename: Lowell F
authors.initials: LF
authors.lastname: Satler
authors.forename: Augusto D
authors.initials: AD
authors.lastname: Pichard
authors.forename: Ron
authors.initials: R
authors.lastname: Waksman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D006328:Cardiac Catheterization / Q000379:methods; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D006350:Heart Valve Prosthesis / Q000009:adverse effects; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D006489:Hemostatic Techniques / Q000009:adverse effects; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods; D016896:Treatment Outcome