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The use of vascularclosure devices andimpact on majorbleeding and netadverse clinicalevents (NACEs) inballoon aorticvalvuloplasty Brian O’NeillVikas SinghAnnapoorna Kini2013 год

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
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Аннотация: 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.© 2013 Wiley Periodicals, Inc.
Год издания: 2013
Авторы: Brian O’Neill, Vikas Singh, Annapoorna Kini, Roxana Mehran, Evan Jacobs, David Knopf, Carlos E. Alfonso, Claudia Martinez, Pedro Martinez‐Clark, William W. O’Neill, Alan W. Heldman, Jennifer Yu, Usman Baber, Jason C. Kovacic, George Dangas, Samin K. Sharma, Samantha Sartori, Mauricio G. Cohen
Издательство: Wiley
Источник: Catheterization and Cardiovascular Interventions
Ключевые слова: Acute Myocardial Infarction Research, Venous Thromboembolism Diagnosis and Management, Cardiac Valve Diseases and Treatments
Другие ссылки: Catheterization and Cardiovascular Interventions (HTML)
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