Vascular access closure in TAVI procedures

Introduction

Transcatheter Aortic Valve Implantation (TAVI) has become a key treatment option for severe aortic stenosis (AS).The invasive character in its earlier years -where the use of general anesthesia and extra corporeal membrane oxygenation (ECMO) was standard- has been replaced by a minimalist approach, using local anesthesia and as little invasive measures as possible. Alongside this transformation, vascular access- and closure has shifted from surgical- cutdown and closure towards a completely percutaneous strategy using ultrasound for access and vascular closure devices (VCD) for closure.11. Toggweiler S, Gurvitch R, Leipsic J, Wood DA, Willson AB, Binder RK, Cheung A, Ye J, Webb JG. Percutaneous aortic valve replacement: vascular outcomes with a fully percutaneous procedure. J Am Coll Cardiol. 2012;59:113-8. Link

Large-bore vascular access is needed to accommodate the big caliber sheaths used in TAVI. Although device- and delivery system alterations have led to smaller size, the sheath sizes used in TAVI still vary from 14 to 18 French.22. Cahill TJ, Chen M, Hayashida K, Latib A, Modine T, Piazza N, Redwood S, Sondergaard L, Prendergast BD. Transcatheter aortic valve implantation: current status and future perspectives. Eur Heart J. 2018;39:2625-2634. Link Consequently, vascular complications in TAVI...