SPC365

Sealing the Deal - Perclose®+Angio-Seal® Vs. MANTA® for Large-Bore Femoral Closure in TAVI

Session: Sessão de Comunicações Orais 01 – Dentro do Laboratório de Hemodinâmica: estratégias contemporâneas e resultados na vida real
Speaker: Catarina Sena Silva

Congress: CPC 2026
Topic: H. Interventional Cardiology and Cardiovascular Surgery
Theme: 25. Interventional Cardiology
Subtheme: 25.3 Non-coronary Cardiac Intervention
Session Type: Comunicações Orais
FP Number: ---
Authors: Catarina Sena Silva; Marta Vilela; Daniel Inácio Cazeiro; João Cravo; Diogo Ferreira; João Fernandes Pedro; Cláudia Jorge; Miguel Nobre Menezes; João Silva Marques; Pedro Cardoso; Fausto J. Pinto; Pedro Carrilho Ferreira

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:'Times New Roman',serif"><span style="color:#000000"><strong>Introduction:</strong></span></span></span><br />
<span style="font-size:12pt"><span style="font-family:'Times New Roman',serif"><span style="color:#000000">Effective closure of large-bore femoral arterial access is essential during transfemoral transcatheter aortic valve implantation (TAVI), in order to avoid significant vascular and bleeding complications. Multiple studies and meta-analyses have suggested that Perclose&reg;&mdash;used alone or in combination with Angio-Seal&reg;&mdash;may offer advantages over alternative closure devices.&nbsp;</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:'Times New Roman',serif"><span style="color:#000000"><strong>Aim:</strong></span></span></span><br />
<span style="font-size:12pt"><span style="font-family:'Times New Roman',serif"><span style="color:#000000">To compare bleeding and vascular outcomes following the use of a hybrid strategy (Perclose&reg; + Angio-Seal&reg;) vs. MANTA&reg; in patients undergoing transfemoral TAVI.</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:'Times New Roman',serif"><span style="color:#000000"><strong>Methods:</strong></span></span></span><br />
<span style="font-size:12pt"><span style="font-family:'Times New Roman',serif"><span style="color:#000000">We conducted a retrospective, single-center analysis of patients who underwent TAVI between November 2022 and September 2025. Baseline and procedural characteristics, as well as in-hospital complications were retrieved from clinical records. Events were adjudicated using Valve Academic Research Consortium 3 (VARC-3) criteria. Predictors of bleeding and vascular outcomes were examined using univariate and multivariable logistic regression.</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:'Times New Roman',serif"><span style="color:#000000"><strong>Results:</strong></span></span></span><br />
<span style="font-size:12pt"><span style="font-family:'Times New Roman',serif"><span style="color:#000000">A total of 346 patients were included (median age 83 years; 54% women), of which 163 were submitted to closure with MANTA&reg; and 183 with a hybrid strategy. Baseline characteristics were broadly comparable between groups, apart from a higher proportion of women (p=0.016) and slightly greater creatinine clearance (56 Vs. 51 mL/min/1.73m</span></span></span><span style="font-size:12pt"><span style="font-family:'Times New Roman',serif"><span style="color:#000000"><sup>2</sup></span></span></span><span style="font-size:12pt"><span style="font-family:'Times New Roman',serif"><span style="color:#000000">) in the hybrid strategy cohort.</span></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:'Times New Roman',serif"><span style="color:#000000">Bleeding events occurred in 40 procedures (12%) and were predominantly classified as&nbsp; VARC-3 type 1 (80%). Overall bleeding rates did not differ significantly between strategies; however, there was a trend to more VARC-3 type 2/3 bleeding among patients treated with MANTA&reg; (1 vs. 7 events; p=0.051; OR 9.00, 95% CI 0.99&ndash;81.93).</span></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:'Times New Roman',serif"><span style="color:#000000">Vascular complications were observed in 33 procedures (10%) and were mostly minor (82%). Patients receiving MANTA&reg; experienced a significantly higher risk of vascular events overall (OR 3.99, 95% CI 1.75&ndash;9.13), with a higher number of major complications (5 Vs. 1, p=NS). In multivariable analysis, MANTA remained an independent predictor of vascular complications (OR 4.10, 95% CI 1.75&ndash;9.62; p&lt;0.001), together with periprocedural use of &ge;2 antithrombotic drugs (OR 5.84, 95% CI 2.29-14.88, p&lt;0.001).</span></span></span></p>

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<span style="font-size:12pt"><span style="font-family:'Times New Roman',serif"><span style="color:#000000"><strong>Conclusions:</strong></span></span></span><br />
<span style="font-size:12pt"><span style="font-family:'Times New Roman',serif"><span style="color:#000000">In this contemporary cohort, the Perclose&reg;+Angio-Seal&reg; strategy was associated with a significantly lower risk of vascular complications and a trend to lower risk of clinically relevant (VARC-3 type 2/3) bleeding compared with MANTA&reg;. These findings reinforce growing evidence that Perclose&reg;-based closure may provide a safer large-bore access management approach in patients undergoing transfemoral TAVI.</span></span></span></p>