SPC365

Vascular closure device in TAVI with a dedicated endovascular plug-based device. Experience from a high-volume tertiary center

Session: Comunicações Orais (Sessão 7) - Intervenção Cardíaca Coronária e Estrutural 1 - Válvula Aórtica
Speaker: Francisco Albuquerque

Congress: CPC 2022
Topic: H. Interventional Cardiology and Cardiovascular Surgery
Theme: 25. Interventional Cardiology
Subtheme: 25.3 Non-coronary Cardiac Intervention
Session Type: Comunicações Orais
FP Number: ---
Authors: Francisco Albuquerque; Daniel a. Gomes; Pedro de Araújo Gonçalves; Pedro Lopes; Mariana Gonçalves; Afonso Félix Oliveira; João Brito; Silvio Leal; Luís Raposo; Henrique Mesquita Gabriel; Rui Campante Teles; Manuel de Sousa Almeida; Miguel Mendes

<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Times New Roman&quot;,serif">[BACKGROUND]:</span></strong></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="background-color:white"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:black">Vascular complications at the access site are important adverse events during transcatheter aortic valve implantation (TAVI). </span></span></span><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:black">Effective, reproducible, and safe closure of large-bore arteriotomies remains challenging as management strategies vary among centers and operators. </span></span><span style="font-family:&quot;Times New Roman&quot;,serif">MANTA</span><sup><span style="font-family:Symbol">TM</span></sup><sup> </sup><span style="font-family:&quot;Times New Roman&quot;,serif">is a dedicated plug-based vascular closure device (VCD) recently approved for percutaneous access site closure. This study aimed to describe our experience and to determine the safety and effectiveness of MANTA</span><sup><span style="font-family:Symbol">TM</span></sup><span style="font-family:&quot;Times New Roman&quot;,serif">&nbsp;for large bore arteriotomies during transfemoral TAVI.</span></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Times New Roman&quot;,serif">[METHODS]:</span></strong></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Times New Roman&quot;,serif">Single-center retrospective analysis on prospectively collected data of all consecutive patients who underwent transfemoral TAVI from 2018 to 2020. The primary safety outcomes were access-related vascular injury and bleeding complications according to VARC-3 criteria. Technical success was defined as puncture closure obtained with MANTA</span><sup><span style="font-family:Symbol">TM</span></sup><span style="font-family:&quot;Times New Roman&quot;,serif"> without the use of unplanned endovascular or surgical intervention. A secondary analysis according to center experience was performed. </span></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Times New Roman&quot;,serif">[RESULTS]:</span></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Times New Roman&quot;,serif">Of the 535 patients that underwent transfemoral TAVI during the study period (median age = 84 [IQR 80-87], 39.4% male; median EuroSCORE II of 3.89 % [IQR 2.62 &ndash; 5.39]), MANTA</span><sup><span style="font-family:Symbol">&Ograve;</span></sup><span style="font-family:&quot;Times New Roman&quot;,serif"> VCD was deployed in 320 (59.8%). Overall, 32 (10.0%) patients suffered an access-related vascular injury and 22 (6.6%) had a bleeding complication <strong><span style="color:#4472c4">(Figure 1-A)</span></strong>. Technical success was achieved in most cases (n=298; 93.1%). 30-day mortality rate was 1.6% (n=5). Since the first deployment in mid-2018, the rates of MANTA-related complications decreased with increasing experience and a steep learning curve effect was noted <strong><span style="color:#4472c4">(Figure 1-B)</span></strong><span style="color:black">.</span> </span></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Times New Roman&quot;,serif">[CONCLUSIONS]:</span></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="background-color:white"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:black">MANTA</span></span></span><sup><span style="font-family:Symbol">TM</span></sup><span style="font-family:&quot;Times New Roman&quot;,serif"> was rapidly adopted as the default strategy for vascular access site closure after TAVI at our center. A relatively steep learning was observed, suggesting that few procedures are required to acquire device proficiency.</span><span style="background-color:white"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:black"> In addition, our results suggest that MANTA </span></span></span><sup><span style="font-family:Symbol">TM</span></sup> <span style="background-color:white"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:black">can effectively close large bore arteriotomies with a low risk of severe complications.</span></span></span></span></span></p>