MANTA Versus Suture-based Closure Devices Following Transcatheter Aortic Valve Replacement: An Updated Meta-analysis

Al‐Abdouh, Ahmad; Abusnina, Waiel; Mhanna, Mohammed; Barbarawi, Mahmoud; Jabri, Ahmad; Bizanti, Anas; Abdel‐Latif, Ahmed; Goldsweig, Andrew M.; Alkhouli, Mohamad; Lichaa, Hady; Kerrigan, Jimmy; Paul, Timir K.

doi:10.1016/j.jscai.2022.100397

Cited by 5 publications

(8 citation statements)

References 36 publications

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“…In contrast to our analysis, none of the previously published meta-analyses could find a difference between the two VCDs in terms of vascular complications [16][17][18]. Most likely, this is due to mixing of RCTs and OS in previous meta-analyses, possibly leading to a high risk of bias and heterogeneity of results.…”

Section: Discussioncontrasting

confidence: 99%

“…Furthermore, all previous metaanalyses did not differentiate between access-site related vascular complications and overall vascular complications (including non-access-site related ones). Furthermore, two of the previous meta-analyses included the ProStar device in the cohort of suture based VCD [16,18], and previous studies have already demonstrated that the ProStar device is inferior to ProGlide [1].…”

Section: Discussionmentioning

confidence: 99%

“…Consequently, meta-analyses comparing both VCDs have been recently performed [16][17][18], but none of them found a difference in terms of vascular complications or bleeding events between both techniques. However, these meta-analyses have important methodological limitations, particularly by mixing OS and randomized controlled trials (RCTs).…”

Section: Introductionmentioning

confidence: 99%

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Comparison of plug-based versus suture-based vascular closure for large-bore arterial access: a collaborative meta-analysis of observational and randomized studies

et al. 2023

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Background Large-bore arteriotomies can be percutaneously closed with suture-based or plug-based vascular closure device (VCD) strategies. The efficacy of both techniques remains controversial. Aims We conducted a meta-analysis of comparative studies between both VCD strategies, focusing on the most commonly applied VCDs (MANTA and ProGlide). Methods We searched MEDLINE, the Cochrane Central Register of Controlled Trials and Google scholar for observational studies (OS) and randomized controlled trials (RCT) comparing vascular closure with the MANTA-based and the ProGlide-based technique. The principal endpoint of this analysis was access-site related vascular complications. Both study types were analyzed separately. Results Access-site related vascular complications were less frequent after vascular closure with the MANTA technique in the analysis of OS (RR 0.61 [95%CI 0.43–0.89], p = 0.01, I2 = 0%), but more frequent in the analysis of RCT data (RR 1.70 [95%CI 1.16–2.51], p = 0.01, I2 = 0%). Both data sets provided no significant difference between the VCD techniques in terms of overall bleeding events (OS: RR 0.57 [95%CI 0.32–1.02], p = 0.06, I2 = 70%; and RCT: RR 1.37 [95%CI 0.82–2.28], p = 0.23, I2 = 30%). RCT data showed that endovascular stenting or vascular surgery due to VCD failure occurred more often after MANTA application (RR 3.53 [95%CI 1.07–11.33], p = 0.04, I2 = 0%). Conclusions While OS point to favorable outcomes for large-bore vascular closure with the MANTA-based technique, RCT data show that this strategy is associated with more access-site related vascular complications as well as endovascular stenting or vascular surgery due to device failure compared with the ProGlide-based technique. Graphical abstract

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Comparison of plug-based versus suture-based vascular closure for large-bore arterial access: a collaborative meta-analysis of observational and randomized studies

et al. 2023

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“…The data from this study are consistent with the literature in terms of vascular complications, with no significant differences between MANTA and suture-based devices [9][10][11][12]25,[29][30][31][32].…”

Section: Vascular Complicationssupporting

confidence: 89%

Vascular Complications Following Transcatheter Aortic Valve Implantation, Using MANTA (Collagen Plug-Based) versus PROSTAR (Suture-Based), from a French Single-Center Retrospective Registry

Benic,

Nicol,

Hannachi

et al. 2023

JCM

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TAVI requires a large-bore arteriotomy. Closure is usually performed by the suture system. Some studies report a vascular complication rate of up to 21%. MANTA is a recently developed percutaneous closure system dedicated to large caliber vessels based on an anchoring system. Early studies report a lower rate of vascular complications with MANTA devices. This single-center retrospective study included all patients who underwent femoral TAVI at the Brest University Hospital from 20 November 2019 to 31 March 2021. The primary endpoint is the rate of vascular complications (major and minor) pre and post-TAVI procedure. In total, 264 patients were included. There were no significant differences in vascular complications (major and minor) between the two groups (13.6% in the MANTA group versus 21.2% in the PROSTAR group; p = 0.105), although there was a tendency to have fewer minor vascular complications in the Manta group (12.1% versus 20.5%; p = 0.067). Manta was associated with a lower rate of bleeding complications (3.8% versus 15.2%; p = 0.002), predominantly minor complications with fewer closure failures (4.5% versus 13.6%; p = 0.01), less use of covered stents (4.5% versus 12.9%; p = 0.016), and with no difference in the need for vascular surgery compared to the Prostar group (1.5% versus 2.3%; p = 0.652). On the other hand, Manta was associated with a higher rate of femoral stenosis (4.5% versus 0%; p = 0.013) without clinical significance (1.5% versus 0%; p = 0.156). The Manta and Prostar devices are equivalent in terms of vascular complications. The Manta, compared to the Prostar, is associated with fewer bleeding complications.

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“…This result is in congruence with 2 clinical trials 14 , 17 and previously published meta-analyses. 20 , 21 , 22 , 23 Two observational studies, by Moriyama et al and Dumpies et al reported a statistically significant lower risk of any bleeding in patients who received MANTA than in those who received ProGlide. 12 , 16 These discordant results can be partly explained by observational nature of both studies, use of only single device for closure in ProGlide group in the study by Dumpies et al, and absence of definite procedure-related learning curve requirement for MANTA usage.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcomes of MANTA vs suture-based vascular closure devices after transcatheter aortic valve replacement: An updated meta-analysis

Doshi

Vasudev

Guragai

et al. 2023

Indian Heart Journal

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MANTA Versus Suture-based Closure Devices Following Transcatheter Aortic Valve Replacement: An Updated Meta-analysis

Cited by 5 publications

References 36 publications

Comparison of plug-based versus suture-based vascular closure for large-bore arterial access: a collaborative meta-analysis of observational and randomized studies

Comparison of plug-based versus suture-based vascular closure for large-bore arterial access: a collaborative meta-analysis of observational and randomized studies

Vascular Complications Following Transcatheter Aortic Valve Implantation, Using MANTA (Collagen Plug-Based) versus PROSTAR (Suture-Based), from a French Single-Center Retrospective Registry

Clinical outcomes of MANTA vs suture-based vascular closure devices after transcatheter aortic valve replacement: An updated meta-analysis

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