Transaxillary Transcatheter Aortic Valve Implantation Utilizing a Novel Vascular Closure Device with Resorbable Collagen Material: A Feasibility Study

Background: We herein aimed to evaluate technical feasibility of transaxillary (Tax) transcatheter aortic valve implantation (TAVI) utilizing a novel vascular closure device with a resorbable collagen plug and absence of suture material. The MANTA device consists of a collagen plug which is low profile, nonthrombogenic, and bioresorbable. Furthermore, a stainless steel lock remains visible in angiography after vessel closure for possible subsequent interventions.

Methods: Between May 2018 and August2018, eight patients (76.0 ± 5.9 years, 62.5% male, log EuroSCORE I 23.6 ± 4.7) received Tax-TAVI using the MANTA vascular closure device. Intraprocedural vascular closure success and postprocedural access site complications were retrospectively analyzed according to VARC-2 definitions.

Results: Puncture location depth was variable (3.5–7.5 cm). The left subclavian artery was used in five cases and the right subclavian artery in three cases. Low-pressure balloon angioplasty for vessel closure was performed in five of eight patients. VARC-2 defined device success was met in all patients. Regarding access site two minor complications (hematoma) without need for reintervention occurred, and one aneurysma spurium of the subclavian artery was seen with consecutive stent implantation on postoperative day 5.

Conclusion: The MANTA device is applicable in Tax-TAVI, with potential particular advantages regarding easiness of use and marked access for subsequent interventions in case of vascular complications. Before conclusions regarding clinical efficacy and safety can be made, the device has to be evaluated in larger patient cohorts.

No conflict of interest has been declared by the author(s).