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Observational Study
. 2014 Jan 1;83(1):148-53.
doi: 10.1002/ccd.24892. Epub 2013 Mar 25.

The use of vascular closure devices and impact on major bleeding and net adverse clinical events (NACEs) in balloon aortic valvuloplasty: a sub-analysis of the BRAVO study

Brian O'Neill  1 , 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, Mauricio G Cohen
Affiliations
Observational Study

The use of vascular closure devices and impact on major bleeding and net adverse clinical events (NACEs) in balloon aortic valvuloplasty: a sub-analysis of the BRAVO study

Brian O'Neill et al. Catheter Cardiovasc Interv. .

Abstract

Objective: To determine the impact of suture-mediated vascular closure devices (VCDs) on net adverse clinical events (NACEs) after balloon aortic valvuloplasty (BAV).

Background: Ischemic and bleeding complications are common following transfemoral BAV; however, previous studies have been single center and limited by varying definitions of major bleeding.

Methods: The 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.

Results: Preclosure 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).

Conclusions: Our 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.

Keywords: aortic stenosis; balloon aortic valvuloplasty; bleeding; closure devices.

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Figures

Figure 1
Figure 1
Comparisons of alternate bleeding definitions according to pre-closure use. VARC bleeding was composite of life threatening and major, TIMI was composite of major and minor, GUSTO was composite of severe or life threatening and moderate, BARC≥3 was any tranfusion with overt bleeding, overt bleeding plus Hb drop ≥5g/dL or intracranial hemorrhage.
Figure 2
Figure 2
Effect of Pre-Closure on Death, MI, and acute vascular injury. Myocardial infarction was according to VARC definition. Acute vascular injury included perforation, arteriovenous fistula, dissection, pseudoaneurysm, perforation or rupture.
Figure 3
Figure 3
Effect of Pre Closure of MACE and NACE
See this image and copyright information in PMC

Comment in

References

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