Single Versus Double Perclose Vascular Closure Device in Transfemoral Transcatheter Aortic Valve Implantation: A Systematic Review and Meta-Analysis

Abstract

Complications related to vascular closure devices (VCDs) remain relatively common after transcatheter aortic valve implantation (TAVI), while the optimal suture-based strategy remains a subject of debate. This systematic review and meta-analysis aim to evaluate the efficacy and safety of single versus double Perclose VCD in patients undergoing transfemoral TAVI. A literature search was conducted across PubMed, Scopus, and Cochrane databases to identify appropriate studies. The primary outcome was technical success; secondary outcomes included vascular and bleeding complications, bailout interventions, and all-cause mortality. Seven studies (3940 patients) fulfilled the inclusion criteria. Technical success was comparable between the two strategies (relative risk [RR]: .89; 95% confidence interval [CI]: .64-1.22), while the single Perclose strategy was associated with a lower risk of major vascular complications (RR: .61; 95% CI: .40-.92), major bleeding (RR: .28; 95% CI: .11-.73) and bailout surgical interventions (RR: .45; 95% CI: .24-.84). There were no differences in minor vascular complications and all-cause mortality. Stepwise closure with the upfront single Perclose strategy demonstrated comparable technical success and a more favorable safety profile regarding major vascular complications and bleeding compared with the double Perclose strategy. Additional randomized controlled trials are essential to validate these findings.