MANTA closure device shows promise in transfemoral transcatheter aortic valve replacement

Abstract

Halim et al. report the results of a single-centre study assessing the efficacy and safety of the use of the MANTA large-bore vascular closure device in transfemoral transcatheter aortic valve replacement (TF-TAVR) [1]. The MANTA closure device showed promise in these patients, although a considerable proportion of them had access-site-related vascular complications. The cohort was small, but the authors used a well-designed study protocol and performed an adequate analysis. The outcomes of earlier studies [2-7] are in line with those reported by Halim et al., describing a prevalence of access-site-related vascular complications-as defined by the Valve Academic Research Consortium-II criteria [8]-ranging from 2-14%. The authors correctly identified a steep learning curve when using the MANTA device, even though they did not analyse this [1]. Hoffman et al. reported a vast decline of complications after the first 25 cases [4]. This is especially useful information for TAVR centre startups in an era in which TAVR is expanding to a broader (i.e. low-risk) population, as the learning curve for suture-based vascular closure devices (i.e. ProGlide and Prostar) is thought to be more extensive in general. The different outcomes for the newer MANTA closure device and the traditionally used suture-based vascular closure devices may very well be explained by each device's advantages, disadvantages and proper indications, which influence patient selection and therefore outcomes.

Major threats to early safety after transcatheter aortic valve implantation in a contemporary cohort of real-world patients

“…Despite considerable advances in the last decade, major adverse events remain a concern after transcatheter aortic valve implantation (TAVI), as they significantly limit quality of life in the affected patients [1][2][3]. This is particularly the case, since improvement of quality of life is considered highly important in this fragile, elderly population, with the highest mean age of all cardiac interventions [4,5]. Therefore, efforts to further reduce these events are likely to yield important clinical benefits [3,6,7].…”