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

## TL;DR

This study compares two types of vascular closure devices used during heart valve replacement procedures and finds that one type causes more minor complications but not higher mortality.

## Contribution

The study is the first to compare 14F plug-based versus suture-based vascular closure devices specifically after low-profile third-generation heart valve delivery sheath use.

## Key findings

- Plug-based devices had higher minor vascular complications (11.6%) compared to suture-based (2.9%).
- No significant difference in major vascular complications or in-hospital mortality between the groups.
- Hospital stay duration was similar for both device types.

## Abstract

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.

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.

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.

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.

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.