Comparison of Safety and Efficacy in Venous Access Closure Using a Double Purse String Suture Technique versus Z-Suture Technique after MitraClip Procedure

Sebastian Frederik Mause^1*Anas Alnaimi¹Nawar Alachkar²Jörg W Schröder¹Mathias Burgmaier³Ertunc Altiok¹Nikolaus Marx¹Sebastian Reith⁴Mohammad Almalla⁵

• ¹Department of Internal Medicine I, Cardiology, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
• ²Department of Cardiology and Rhythmology, St. Josef-Hospital of the Ruhr University Bochum, Bochum, Germany
• ³Faculty of Applied Healthcare Science, Deggendorf Institute of Technology, Deggendorf, Germany
• ⁴Department of Internal Medicine III, St. Franziskus Hospital Münster, Münster, Germany
• ⁵Madinah Cardiac Center, Medina, Medina, Saudi Arabia

Background: Percutaneous mitral valve repair using the MitraClip System is a well-established therapeutic option for patients with symptomatic mitral regurgitation. This procedure is usually performed via venous femoral access using a 24-French guiding catheter. Since vascular complications and bleeding remain a relevant limitation, we now compared access closure using subcutaneous absorbable double purse string suture (DPSS) and Z-suture technique following MitraClip procedure.Methods: 249 patients (mean age 76±8 years) who underwent MitraClip procedure at our institution were included. Venous closure was performed using Z-suture technique in 140 patients and DPSS technique in 109 patients. Vascular complications and bleeding events were assessed according to the Mitral Valve Academic Research Consortium (MVARC) criteria.Results: MVARC minor and major vascular complications were comparable after closure with Zsuture and DPSS-technique (4.3% vs. 0.9%, p=0.11 and 1.4% vs. 0.9%, p= 0.71, respectively). However, development of AV-fistula and requirement of access related surgical intervention was more often observed in the Z-suture group (5% vs. 0%, p=0.018 and 3.5% vs. 0%, p=0.045). MVARC minor and major, non-life-threatening bleeding did not differ between the two groups (10.7% vs. 12.9%, p=0.61 and 0.7% vs. 0.0%, p= 0.38). Similarly, overall transfusion rates and access related blood transfusion rates were comparable (11.4% vs. 15.5%, p=0.34 and 4.3% vs. 2.7%, p=0.52).Large caliber venous access closure with DPSS technique was feasible, safe, and effective to achieve haemostasis after MitraClip procedure. Compared with Z-suture, use of DPSS closure was associated with a lower rate of required access related surgical intervention and postinterventional AVfistula.