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Pledget-assisted hemostasis to fix residual access-site bleedings after double pre-closure technique

World Journal of Cardiology 2022年第5期14卷 297-306页

作者： Francesco Burzotta Cristina Aurigemma Mila Kovacevic Enrico Romagnoli Stefano Cangemi francecso bianchini Marialisa Nesta Piergiorgio Bruno Carlo Trani Dipartimento di Scienze Cardiovascolari Fondazione Policlinico Universitario A Gemelli IRCCSRome 00168Italy UniversitàCattolica del Sacro Cuore Rome 00168Italy Faculty of Medicine University of Novi SadNovi SadSerbia Institute of Cardiovascular Diseases of Vojvodina Cardiology ClinicSremska KamenicaSerbia

BACKGROUND The use of pre-closure suture-based devices represents a widely access-site hemostasis technique in percutaneous transfemoral transcatheter-aortic-valvereplacement(TF-TAVR);yet this technique is associated with the risk of a device failure that may result in clinically relevant residual ***,a bailout intervention is *** far,the best management of pre-closure device failure has not been *** To report the first clinical results obtained using a novel bailout hemostasis technique for patients with double suture-based vascular closure device failure in the setting of *** We developed a“pledget-assisted hemostasis”technique to manage residual access-site *** consists of the insertion of a surgical,non-absorbable,polytetrafluoroethylene pledget over the sutures of the two ProGlide(Abbott Vascular,CA,United States).The ProGlide’s knot-pushers are used to push down the pledget and the hand-made slipknot to seal the femoral artery *** technique was used as a bailout strategy in patients undergoing TF-TAVR with a systematic double pre-closure ***-procedural access-site angiography was systematically ***-hospital complications were systematically detected and classified according to Valve Academic Research Consortium-2 *** Out of 136 consecutive patients who underwent TF-TAVR,15 patients(mean age 80.0±7.2 years,66.7%female)with access-site bleeding after double pre-closure technique failure were treated by pledget-assisted *** the majority of patients,16F sheath was used(n=12;80%).In 2 cases(13%),a peripheral balloon was also inflated in the iliac artery to limit blood loss during pledget ***-confirmed hemostasis(primary efficacy endpoint)was achieved in all *** the procedure,1 patient required blood transfusion(2 units),and no other bleeding or major ischemic complication was *** The“pledget assisted hemostasis”might be con

关键词： Transcatheter aortic valve replacement Transcatheter aortic valve implantation Vascular complications Preclosure device Pledget Hemostasis Personalized medicine

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