Propensity Matched Analysis of 14 French Suture- Versus Plug-Based Vascular Closure During Transfemoral Transcatheter Aortic Valve Replacement (TAVR)

Background: Plug-based vascular closure devices (Pb-VCD) and suture-based vascular closure devices (Sb-VCD) are used for percutaneous vascular access site closure during transcatheter aortic valve replacement (TAVR). Until now, no clear superiority of either device was shown in studies comparing 18 F VCDs solely. However, there is no data exclusively comparing the 14 F Pb-VCDs against Sb-VCDs after novel 14 F low-profile third-generation heart valve delivery sheath use with focus on vascular complications. Aims: This study aimed to compare the safety and efficacy of 14 F Pb-VCD to Sb-VCD following 14 F low-profile transcatheter heart valve delivery sheath use during TAVR. Methods: We performed a retrospective, propensity score-matched comparison of patients receiving either the 14 F Pb-VCD or the Sb-VCD after 14 F low-profile third-generation heart valve delivery sheath use during TAVR. Valve academic research consortium-3 (VARC-3) criteria were used to define the primary endpoint of major and minor vascular complications at the access site. Secondary endpoints included length of hospital stay and in-hospital mortality. Results: Two hundred and fifteen (Sb-VCD) and 169 (Pb-VCD) patients were included in propensity score matching and resulted in 69 matched patient pairs. The primary endpoint of major vascular complications was comparable between the groups (8.7% [Sb-VCD] vs. 5.8% [Pb-VCD], p = 0.511), whereas minor vascular complications were more frequent in the Pb-VCD group (2.9% vs. 11.6%, p = 0.049). Secondary endpoints of length of hospital stay (p = 0.270) and in-hospital mortality (p = 0.366) were balanced between the groups. Conclusion: 14 F Pb-VCDs are associated with significantly higher rates of VARC-3 defined minor vascular complications after 14 F delivery sheath utilization during TAVR, not leading to increased in-hospital patients' mortality. Adequate vascular closure following transfemoral TAVR remains of high clinical significance and continuous efforts are needed to optimize vascular access and closure strategies.