• Brian O'Neill, Vikas Singh, Annapoorna Kini, Roxana Mehran, Evan Jacobs, David Knopf, Carlos E Alfonso, Claudia A Martinez, Pedro Martinezclark, William O'Neill, Alan W Heldman, Jennifer Yu, Usman Baber, Jason C Kovacic, George Dangas, Samin Sharma, Samantha Sartori, and Mauricio G Cohen.
• Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida.
• Catheter Cardiovasc Interv. 2014 Jan 1; 83 (1): 148-53.

ObjectiveTo determine the impact of suture-mediated vascular closure devices (VCDs) on net adverse clinical events (NACEs) after balloon aortic valvuloplasty (BAV).BackgroundIschemic and bleeding complications are common following transfemoral BAV; however, previous studies have been single center and limited by varying definitions of major bleeding.MethodsThe Effect of Bivalirudin on Aortic Valve Intervention Outcomes (BRAVOs) study was a retrospective observational study conducted at two high-volume academic centers over a 6-year period designed to compare the effect of bivalirudin versus unfractionated heparin. This is a subanalysis of 428 consecutive patients who underwent BAV (with 10-13 French sheaths) to compare the effect of hemostasis with VCDs versus manual compression utilizing standardized definitions. NACE was defined as the composite of major bleeding and major adverse clinical events (MACEs). All events were adjudicated by an independent clinical events committee who were blinded to antithrombin use.ResultsPreclosure was performed in 269 (62.8%) of patients. While bivalirudin was used more frequently in those with pre-closure (60.6% vs. 37.7%, P < 0.001), a history of prior BAV (11.1% vs. 3.6%, P = 0.04) and peripheral vascular disease (30.7% vs. 19.7%, P = 0.01) was more common in those not undergoing preclosure (n = 159, 37%). Other clinical and demographic features were well balanced between groups. Vascular closure was associated with a significant reduction in NACE (24.5% vs. 10.0% P < 0.001). Results remained significant after adjusting for baseline differences and bivalirudin use (OR 0.38, 95% CI: 0.21-0.68; P = 0.001).ConclusionsOur study suggests that suture-mediated vascular closure is associated with a substantial reduction in NACE after transfemoral BAV. Large randomized clinical trials should be conducted to confirm our results.Copyright © 2013 Wiley Periodicals, Inc.

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