Comparison of Closure Strategies After Balloon Aortic Valvuloplasty: Suture Mediated Versus Collagen Based Versus Manual
Comparison of Closure Strategies After Balloon Aortic Valvuloplasty: Suture Mediated Versus Collagen Based Versus Manual
复制标题
DOI：
10.1002/ccd.22940
复制
发表时间：
2011-07-01
影响因子：
2.3
通讯作者：
Waksman, Ron
中科院分区：
文献类型：
--
作者：
Ben-dor, Itsik;Looser, Patrick;Waksman, Ron
目的：比较球囊主动脉瓣成形术（BAV）后胶原蛋白介导闭合器械、缝线介导闭合技术和手动压迫用于穿刺部位管理的并发症发生率。背景资料：血管并发症，包括穿孔、肢体缺血、动静脉瘘和假性动脉瘤，是接受大口径股动脉入路BAV的患者的常见发病原因。穿刺部位闭合的可用选项包括手动压迫、缝线介导的闭合器械和最近报告的胶原基闭合器械。方法：研究队列包括333例接受BAV的重度主动脉瓣狭窄患者。根据入路闭合方法将患者分为4组：（1）64例（19.2%）采用手动压迫;（2）162例（48.6%）采用Proglide 6 Fr;（3）89例（26.75%）采用Angio-Seal 8 Fr;（4）18例（5.4%）采用Prostar 10 Fr。结果如下：各组之间的基线特征无显著差异;尽管Prostar组男性较多，Angio-Seal组报告的肾衰竭和外周血管疾病发生率较低。Angio-Seal组的手术持续时间短于其他组。在Angio-Seal组（n = 47，52.8%）中，10 Fr鞘管尺寸主要用于进入股动脉，而手动压迫组和Proglide组分别有29例（45.3%）和66例（40.7%）患者使用12 Fr鞘管。Prostar组使用13 Fr鞘管（n = 11，61.1%），P < 0.001。Proglide组（n = 20，12.3%）的器械失效率显著高于Angio-Seal组（n = 3，3.3%）和Prostar组（n = 1，5.5%），P = 0.03。手动压迫组（n = 11，17.1%）需要干预的严重血管并发症显著高于Proglide组（n = 11，6.7%）、Angio-Seal组（n = 5，5.6%）和Prostar组（n = 5，1%），P < 0.001。Angio-Seal组的输血需求（n = 7，7.8%）显著低于手动压迫组（n = 20，31.2%）、Proglide组（n = 35，21.6%）和Prostar组（n = 5，27.7%），P < 0.001。结论：在我们的病例系列中，BAV后胶原基闭合器械和缝线介导闭合器械的血管并发症少于手动压迫止血。胶原蛋白缝合与缝线缝合的患者选择需要进一步研究。(C)2011 Wiley-Liss，Inc.
Objectives: To compare complication rates of a collagen-mediated closure device, suture-mediated closure technique and manual compression for access site management following balloon aortic valvuloplasty (BAV). Background: Vascular complications, including perforation, limb ischemia, ateriovenous fistulas, and pseudoaneurysm, are a common source of morbidity in patients undergoing BAV with large bore femoral artery access. The available options for closure of the access site include manual compression, suture-mediated closure devices, and recently reported collagen-based closure devices. Methods: The study cohort consisted of 333 patients with severe aortic stenosis undergoing BAV. Patients were divided into four groups according to access closure method: (1) Manual compression in 64 (19.2%); (2) Proglide 6 Fr in 162 (48.6%); (3) Angio-Seal 8 Fr in 89 (26.75%); and (4) Prostar 10 Fr in 18 (5.4%). Results: There were no significant differences in baseline characteristics among the groups; although the Prostar group was had more males and the Angio-Seal group reported a lower incidence of renal failure and peripheral vascular disease. The Angio-Seal group had shorter procedural duration times compared with the other groups. In the Angio-Seal group (n = 47, 52.8%), a 10 Fr sheath size was primarily used to access the femoral artery, as compared with the manual compression and Proglide groups, which used a 12 Fr sheath in 29 (45.3%) and 66 patients (40.7%), respectively. A 13 Fr sheath was used in the Prostar group (n = 11, 61.1%), P < 0.001. The device failure rate was significantly higher in the Proglide group (n = 20, 12.3%) as compared with Angio-Seal (n = 3, 3.3%) and Prostar groups (n = 1, 5.5%), P = 0.03. Serious vascular complications requiring intervention were significantly higher in the manual compression group (n = 11, 17.1%) compared with the Proglide (n = 11, 6.7%), Angio-Seal (n = 5, 5.6%), and Prostar groups (n = 5, 1%), P < 0.001. The requirement for blood transfusion in the Angio-Seal group was significantly lower (n = 7, 7.8%) as compared with the manual compression (n = 20, 31.2%), Proglide (n = 35, 21.6%), and Prostar groups (n = 5, 27.7%), P < 0.001. Conclusion: In our case series, collagen-based closure devices and suture-mediated closure devices had fewer vascular complications than manual compression for hemostasis following BAV. Patient selection for collagen-based versus suture-mediated closure requires further study. (C) 2011 Wiley-Liss, Inc.