Journal of the Society for Cardiovascular Angiography & Interventions · 2026
Hybrid Suture- and Plug-Based Closure Versus Dual Suture Devices in Transfemoral Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-analysis.
СтатьяОбзорНазвание и аннотация: Перевод в очереди
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Moeez Abdul, Shah Syed Wajihullah, Huma Sundus, Salma Shabbar Banatwala Umm E, Ali Aizaz, Khattak Lintha Zafar, Bacha Zaryab, Khan Afra, Shaid Fazlina, Azeem Touba, Razzaq Sayyam, Khan Malik Waleed Zeb, Ikram Jibran, Ullah Farid, Shaban Mohammed
Аннотация
BACKGROUND: Effective vascular closure is crucial in transfemoral transcatheter aortic valve replacement (TAVR) to minimize access-related complications. Although dual suture-based closure is widely used, a hybrid approach combining suture- and plug-based vascular closure devices (VCD) has gained increasing attention. This meta-analysis compared these 2 strategies in terms of vascular outcomes and procedural success.
METHODS: A systematic review and meta-analysis were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. PubMed, Embase, and Web of Science were searched through January 2025 for studies comparing suture-plus-plug-based vs suture-based VCD in TAVR patients. Primary outcomes were major and minor vascular complications, bleeding events, VCD failure, and unplanned interventions. Risk ratios (RRs) with 95% CIs were calculated.
RESULTS: Six studies involving 2308 patients were included. The suture-plus-plug-based approach significantly reduced major vascular complications (RR, 0.50; P = .001), minor vascular complications (RR, 0.58; P < .00001), and VCD failure (RR, 0.26; P < .00001) compared with suture-based closure alone. No significant differences were observed in major (P = .30) or minor bleeding (P = .47). Unplanned interventions were less frequent with the hybrid approach, but the difference was not statistically significant (RR, 0.68; P = .19).
CONCLUSIONS: The combination of suture- and plug-based closure devices in transfemoral TAVR provides superior vascular outcomes and lower device failure rates without increasing bleeding risk. These findings support the hybrid approach as a safe and effective strategy, although further randomized controlled trials are warranted to confirm long-term outcomes.
METHODS: A systematic review and meta-analysis were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. PubMed, Embase, and Web of Science were searched through January 2025 for studies comparing suture-plus-plug-based vs suture-based VCD in TAVR patients. Primary outcomes were major and minor vascular complications, bleeding events, VCD failure, and unplanned interventions. Risk ratios (RRs) with 95% CIs were calculated.
RESULTS: Six studies involving 2308 patients were included. The suture-plus-plug-based approach significantly reduced major vascular complications (RR, 0.50; P = .001), minor vascular complications (RR, 0.58; P < .00001), and VCD failure (RR, 0.26; P < .00001) compared with suture-based closure alone. No significant differences were observed in major (P = .30) or minor bleeding (P = .47). Unplanned interventions were less frequent with the hybrid approach, but the difference was not statistically significant (RR, 0.68; P = .19).
CONCLUSIONS: The combination of suture- and plug-based closure devices in transfemoral TAVR provides superior vascular outcomes and lower device failure rates without increasing bleeding risk. These findings support the hybrid approach as a safe and effective strategy, although further randomized controlled trials are warranted to confirm long-term outcomes.