Eccentricity of large bore femoral artery puncture during TAVI with collagen-based vascular closure device and vascular complications

Aim: Vascular complications continue to be a major source for morbidity and mortality in TAVI patients. Manta vascular closure device was recently introduced for large bore vascular closure, however the effect of puncture technique on the associated complication rate was not described yet.

Methods and results
We performed a retrospective analysis of consecutive patients undergoing transfemoral TAVI in which Manta closure device was used. Eccentric puncture was defined as a puncture lateral or medial by more than 25% of the vessel width from the artery center. Eccentricity was analyzed using the Manta radiopaque lock as the puncture site marker in AP projection after vascular closure. The primary outcome was composite of major vascular complication (VARC-2) or major bleeding (VARC-2) or in-hospital death or need for covered stent or need for peripheral balloon.
Results

A total of 111 patients received Manta device during TAVI from April 2020 to April 2021. Median age was 81years and 55 (50%) were males. Eccentric puncture occurred in 55.5% of patients . The primary end point occurred in 21.3% in the eccentric group and in 10.4% in the central puncture group. The relative risk (RR) for the primary end point was 2.05, P= 0.128. Major vascular complication was found in 9.8% vs. 4.3%, RR=2.36 P=0.26. In 5.5% a covered stent was used and in 8.2% a peripheral balloon was used. Balloons were used in 11.5% vs. 4.2% RR=2.75 P=0.17.

Conclusion
Eccentric femoral artery puncture is very frequent in TAVI procedures and is associated with a trend towards doubling the vascular complication rate. We plan to increase the statistical power of the study and present updated outcomes during the meeting. Proper technique such as US guided puncture might, therefore, assist in central vessel puncture and decrease the rate of TAVI vascular complication.