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首页> 美国卫生研究院文献>Journal of Cardiology Cases >Use of the MANTA device to rescue failed pre-closure following transfemoral transcatheter aortic valve implantation
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Use of the MANTA device to rescue failed pre-closure following transfemoral transcatheter aortic valve implantation

机译：经股动脉经导管主动脉瓣植入后使用MANTA装置抢救失败的预闭合

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Access site vascular complications remain relatively frequent following trans-femoral (TF) transcatheter aortic valve implantation (TAVI), and are associated with significant morbidity as well as increased mortality. Suture-based vascular closure devices (VCD) are widely used and have been demonstrated to reduce the rate of vascular complications. However, failure to achieve adequate hemostasis following their use occurs in some cases, and may necessitate surgical escalation.We report a case of a patient with complex ileo-femoral anatomy in whom the novel plug-based MANTA VCD was successfully used to achieve hemostasis post-TF TAVI following failed closure with ProGlides®. A 79-year-old male underwent valve-in-valve TF TAVI for the treatment of severe degenerative disease of a Mitroflow prosthesis. Pre-procedural imaging demonstrated tortuous and calcific ileo-femoral arteries and torrential bleeding occurred following sheath removal and deployment of the pre-sited ProGlides®. Consideration was given to surgical intervention but the decision was taken to attempt rescue closure using a 14F MANTA VCD. Hemostasis was successfully achieved and the patient recovered well.Early data assessing the efficacy of the MANTA VCD have been promising and this relatively novel technology appears to be a viable alternative to established VCDs.<>Learning objective: Access site vascular complications remain relatively frequent following trans-femoral (TF) transcatheter aortic valve implantation (TAVI), and are associated with significant morbidity and mortality. The MANTA vascular closure device (VCD) appears to be a promising alternative to established VCDs. Early data from clinical trials suggests that the MANTA may be non-inferior to currently used suture-based VCDs. Furthermore, experience from our case demonstrates its utility as a rescue device for emergency hemostasis when more traditional measures have failed.>
机译：经股动脉（TF）经导管主动脉瓣植入（TAVI）后，进入部位的血管并发症仍然相对频繁，并且与明显的发病率和更高的死亡率相关。基于缝合线的血管闭合装置（VCD）已被广泛使用，并已被证明可以降低血管并发症的发生率。然而，在某些情况下，使用后未能达到足够的止血效果，可能需要进行手术升级。我们报道了一例具有复杂股回股骨解剖结构的患者，其中成功使用新型的基于插头的MANTA VCD实现止血-TF TAVI使用ProGlides ®关闭失败。一名79岁的男性接受了瓣膜活门TF TAVI的治疗，以治疗Mitroflow假体的严重退行性疾病。术前影像学检查显示回肠股骨动脉曲折和钙化，并在鞘管切除和部署ProGlides ®后发生股骨头出血。考虑了手术干预，但决定尝试使用14F MANTA VCD进行抢救。成功地实现了止血并且患者康复了。早期评估MANTA VCD疗效的数据是有希望的，并且这种相对新颖的技术似乎可以替代已建立的VCD。 strong>学习目标：经股动脉（TF）经导管主动脉瓣植入（TAVI）后，血管并发症仍然相对频繁，并且与明显的发病率和死亡率相关。 MANTA血管闭合装置（VCD）似乎是成熟VCD的有希望的替代品。来自临床试验的早期数据表明，MANTA可能不逊于当前使用的基于缝线的VCD。此外，从我们的案例中获得的经验表明，当更多传统措施失败时，它可用作紧急止血的救援设备。

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