Access site closure after TAVI: invincible sutures

Suture-based vascular closure device (VCD) strategies were the only available percutaneous option for large-bore arterial access site closure for more than two decades. A continuously increasing demand for more ideal solutions, particularly driven by the growing number of transfemoral transcatheter aortic valve implantation (TAVI) procedures, has prompted the development of novel, tailored large-bore VCDs. In 2016, the large-bore plug-based MANTA device (Teleflex) was introduced, raising hopes for faster and more secure vascular closure, as suggested by early non-randomised studies123. However, the MANTA device failed to meet these high expectations in two randomised controlled trials (RCTs). While the small-sized MASH trial demonstrated no superiority using two Perclose ProGlide devices (Abbott) compared to a suture-based strategy4, the larger CHOICE-CLOSURE trial reported significantly higher vascular complication rates with the MANTA plug5. Despite these disappointing results from two RCTs, the comparison of suture-based and plug-based VCDs remains contentious.

In this issue of EuroIntervention, Grundmann et al provide a large propensity score-matched registry analysis (the Plug or sUture based vascuLar cloSurE after TAVI [PULSE] registry), further tipping the scale in favour...