Abstract 9869: Collagen-plug based Vascular Closure Devices can they Decrease Vascular and Bleeding Complications occurring After Balloon Aortic Valvuloplasty ?
Introduction: Whereas they are controversial after coronary angioplasty, we assessed the hypothesis that the use of vascular closure devices (VCDs) after balloon aortic valvuloplasty (BAV), may decrease vascular and bleeding complications of the procedure.
Methods: We conducted a prospective analysis of consecutive patients who underwent BAV in our center between 2009 and 2012. BAV was performed by femoral retrograde technique using 8 to 10 French sheaths. Group 1 consists of patients from which femoral puncture hemostasis was obtained with use of a 8 French collagen-plug based VCD (Angio-seal, St Jude Medical), group 2 consists of patients who have manual or mechanical compression (FemoStop, RADI Medical systems) of the femoral puncture site. We collected all major in-hospital adverse events, major bleeding (≥ BARC 3) and serious vascular access complications (pseudoanerysm, arterio venous fistula or acute limb ischemia).
Results: Overall, 180 patients were included in that study. Indications for performing BAV included bridge to surgery (n=27), bridge to TAVI (n=71), therapy before extra cardiac surgery (n=35) or palliative (n=47). The two groups had similar median age (84 years) and previous lower extremity artery disease (overall n= 47, 26%, p=0.79). Vascular and bleeding complications occurred overall among 11.7% of the patients (n=21) and were more frequent in group 1 (p=0;02; table 1). Five of the 6 patients who suffered acute limb ischemia belonged to this group (p= 0.15). The rate of complications was the same whatever was the size if the sheath used.
In conclusion, this study shows that collagen-plug based vascular closure devices increase vascular and bleeding complications occurring after balloon aortic valvuloplasty. Except in high risk bleeding patients, in whom femoral hemostasis can be difficult to obtain, the systematic use of these devices in a population of elderly patients with often advanced limb atherosclerosis, is questionable.
- © 2013 by American Heart Association, Inc.