Kahlert Philipp, Eggebrecht Holger, Erbel Raimund, Sack Stefan
West German Heart Center Essen, Department of Cardiology, University Duisburg-Essen, Germany.
Catheter Cardiovasc Interv. 2008 Nov 15;72(6):877-84. doi: 10.1002/ccd.21711.
To evaluate the feasibility, safety and efficacy of suture-mediated closure devices using a modified "preclosure" technique for access site management after percutaneous aortic valve replacement (PAVR).
PAVR using a retrograde transfemoral approach has recently evolved to an endovascular alternative to open surgery in high-risk patients. However, large-bore femoral artery access is required, commonly demanding surgical closure and general anesthesia. A truly percutaneous intervention would be desirable to reduce procedural complexity and diminish the need of vascular surgery and general anaesthesia.
After direct puncture of the common femoral artery, three conventional suture-mediated closure devices (6F Perclose) were deployed. The preloaded sutures were tied at the end of the procedure. If no immediate hemostasis was achieved, an additional device was deployed thereafter.
PAVR with percutaneous access site closure was attempted in 15 consecutive patients and could successfully be achieved in all patients allowing conscious sedation in all but three cases. Following complications occurred: one retroperitoneal bleeding caused by removal of the valve delivery sheath requiring surgical repair, as well as two cases of femoral and iliac artery dissection caused by delivery sheath introduction and treated by stenting and vascular surgery, respectively. Vascular surgery became only necessary due to total vessel occlusion after suture closure and remains the only closure-related complication. However, treatment led to recovery in all patients.
The modified "preclosure" technique is a feasible and safe method for hemostasis after PAVR improving procedural management and diminishing the need for general anesthesia.
评估使用改良“预闭合”技术的缝合介导闭合装置在经皮主动脉瓣置换术（PAVR）后用于穿刺部位管理的可行性、安全性和有效性。
采用逆行经股动脉入路的PAVR最近已发展成为高危患者开放性手术的血管内替代方法。然而，需要大口径股动脉穿刺，通常需要手术闭合和全身麻醉。真正的经皮干预将有助于降低手术复杂性，并减少血管外科手术和全身麻醉的需求。
在直接穿刺股总动脉后，部署三个传统的缝合介导闭合装置（6F Perclose）。预加载的缝线在手术结束时打结。如果未立即实现止血，则随后部署额外的装置。
连续15例患者尝试进行经皮穿刺部位闭合的PAVR，所有患者均成功完成，除三例患者外均允许清醒镇静。发生以下并发症：一例因移除瓣膜输送鞘导致腹膜后出血，需要手术修复；两例因输送鞘插入导致股动脉和髂动脉夹层，分别通过支架置入和血管外科手术治疗。仅因缝合闭合后血管完全闭塞才需要进行血管外科手术，这仍然是唯一与闭合相关的并发症。然而，所有患者经治疗后均康复。
改良的“预闭合”技术是PAVR后止血的一种可行且安全的方法，可改善手术管理并减少全身麻醉的需求。
