Published online May 26, 2022. doi: 10.4330/wjc.v14.i5.297
Peer-review started: October 17, 2021
First decision: January 25, 2022
Revised: February 6, 2022
Accepted: April 24, 2022
Article in press: April 24, 2022
Published online: May 26, 2022
Processing time: 212 Days and 16.7 Hours
The most common technique used for hemostasis in transfemoral transcatheter aortic valve replacement (TF-TAVR) is the use of pre-closure devices. Despite favorable results in terms of successful hemostasis, sometimes it can be followed by device failure and residual bleeding.
Although there are different possibilities to manage residual bleeding after hemostasis device failure, such as bailout additional closure device use, balloon-assisted hemostasis, or surgery, the best management is still unclear.
To describe and report the results of an original technique for managing residual access site bleeding after vascular closure devices failure.
The authors developed a novel technique to resolve residual access-site bleeding named “pledget assisted hemostasis”. If residual bleeding was noticed, “pledget assisted hemostasis” with surgical non-absorbable polytetrafluoroethylene 6.5 mm x 4 mm x 1.5 mm pledget was done on the top of double pre-closure device. Proper hemostasis without residual bleeding was confirmed with control angiography.
A total of 15 consecutive patients (mean age 80.0 ± 7.2 years, 66.7% female) with residual access site bleeding after double pre-closure in TF-TAVR were prospectively included in this pilot study. In the majority of patients 16F sheath was used (n = 12; 80%), 14F sheath was used in 2 patients (6.7%), and 18F in 1 patient (6.7%). Hemostasis with the pledget technique was achieved in all patients (100%) immediately after implantation. Major bleeding defined by Valve Academic Research Consortium-2 definition did not occur. No access site infection was observed in the follow-up period.
“Pledget assisted hemostasis” after pre-closure vascular device failure might be considered as a possible bailout technique to treat patients with residual access site bleeding. Further studies are needed to compare this approach with other bail-out techniques.
“Pledget assisted hemostasis” might be considered as a possible bailout technique for vascular closure device failure.