Al-Abdouh Ahmad, Abusnina Waiel, Mhanna Mohammed, Barbarawi Mahmoud, Jabri Ahmad, Bizanti Anas, Abdel-Latif Ahmed, Goldsweig Andrew M, Alkhouli Mohamad, Lichaa Hady, Kerrigan Jimmy, Paul Timir K
Department of Hospital Medicine, University of Kentucky, Lexington, Kentucky.
Department of Cardiology, Creighton University School of Medicine, Omaha, Nebraska.
J Soc Cardiovasc Angiogr Interv. 2022 Jun 30;1(5):100397. doi: 10.1016/j.jscai.2022.100397. eCollection 2022 Sep-Oct.
Vascular access closure is essential in large-bore arteriotomy procedures, such as transcatheter aortic valve replacement. Suture-based devices are frequently used for vascular access closure. MANTA (Teleflex) is a collagen plug-based device used to achieve hemostasis with evolving efficacy and safety data. This study aimed to evaluate plug-based versus suture-based closure devices following large-bore arteriotomy procedures.
We conducted a systematic review searching PubMed, Cochrane Library, and ClinicalTrials.gov (inception through November 2021) for studies evaluating plug-based versus suture-based closure devices following large-bore arteriotomy procedures. We performed a meta-analysis comparing the length of stay, device failure, mortality, bleeding, and vascular complications between these 2 types of devices.
Eleven studies (2 randomized controlled trials and 9 observational studies) with a total of 3123 patients were included in this analysis. Compared with suture-based devices, plug-based devices were associated with a significant decrease in the length of stay (standardized mean difference: -0.14; 95% CI, -0.25 to -0.03) and vascular closure device failure (odds ratio, 0.63; 95% CI, 0.44-0.91) following the procedure. There were no significant differences in all-cause mortality, major or minor bleeding, and major or minor vascular complications between plug-based and suture-based closure devices.
Plug-based vascular closure devices were associated with a shorter length of stay and lower risk of device failure following large-bore arteriotomy procedures without differences in mortality, bleeding, or vascular complications than suture-based closure devices.
血管通路闭合在大口径动脉切开术（如经导管主动脉瓣置换术）中至关重要。基于缝线的装置常用于血管通路闭合。MANTA（泰利福公司）是一种基于胶原塞的装置，用于实现止血，其疗效和安全性数据不断发展。本研究旨在评估大口径动脉切开术后基于塞子的闭合装置与基于缝线的闭合装置。
我们进行了一项系统评价，在PubMed、Cochrane图书馆和ClinicalTrials.gov（从创建到2021年11月）中检索评估大口径动脉切开术后基于塞子的闭合装置与基于缝线的闭合装置的研究。我们进行了一项荟萃分析，比较这两种装置之间的住院时间、装置失败、死亡率、出血和血管并发症。
本分析纳入了11项研究（2项随机对照试验和9项观察性研究），共3123例患者。与基于缝线的装置相比，基于塞子的装置在术后住院时间（标准化平均差：-0.14；95%CI，-0.25至-0.03）和血管闭合装置失败（优势比，0.63；95%CI，0.44 - 0.91）方面显著降低。基于塞子的闭合装置与基于缝线的闭合装置在全因死亡率、大出血或小出血以及大血管或小血管并发症方面无显著差异。
在大口径动脉切开术后，基于塞子的血管闭合装置与较短的住院时间和较低的装置失败风险相关，与基于缝线的闭合装置相比，在死亡率、出血或血管并发症方面无差异。
