Application of Single Versus Double-ProGlide Devices for Vascular Access Closure After Transfemoral Transcatheter Aortic Valve Implantation in Korean Patients

Abstract

Background and Objectives: The double-ProGlide technique is commonly used to achieve hemostasis in patients undergoing transfemoral transcatheter aortic valve replacement (TAVR). However, it has been associated with the rise of access-site stenosis. Therefore, in this study, we compared the safety and effectiveness of the single-ProGlide technique, with the option to deploy additional ProGlides if needed, to the double-ProGlide method in patients undergoing transfemoral TAVR. Methods: In this single-center retrospective study, we included 551 patients who underwent transfemoral TAVR from May 2016 to July 2022. Propensity score matching was performed to control for confounding factors, resulting in two matched groups of 175 patients each. Primary outcomes included the technical success of vascular closure, immediate procedural results, 30-day clinical outcomes, and access-related vascular complications. Results: Baseline characteristics were similar between the two groups after matching. No significant differences were observed in the immediate procedural results and 30-day clinical outcomes in the two groups. The single-ProGlide group showed a higher technical success rate for vascular closure (90.3% for single vs. 86.3% for double; p = 0.24) and a lower rate of any vascular complication (9.7% vs. 16.0%, p = 0.079) compared to the double-ProGlide group, although these differences did not reach statistical significance. Female sex (odds ratio [OR] 2.87, 95% confidence interval [CI] 1.48-5.93, p = 0.003), smaller access vessel diameter (OR 0.65, 95% CI 0.50-0.82, p < 0.001), and increased number of ProGlides used (OR 4.94, 95% CI 2.46-10.6, p < 0.001) were associated with vascular closure device failure. Conclusions: The single-ProGlide technique, with the option to use additional devices as required, appears to be a viable alternative to the double-ProGlide technique. It demonstrated high technical success for main-access closure and a trend toward lower vascular complication rates in transfemoral TAVR, although these differences did not reach statistical significance.