Background: Percutaneous mitral valve repair (PMVR) using the MitraClip System is a well-established therapy for patients with symptomatic mitral regurgitation, who are inoperable or at high surgical risk. This procedure is usually performed via femoral vein access using a 24-French guiding catheter.

Purpose. This study evaluates incidence of vascular complications after closure of venous access using subcutaneous absorbable double purse string suture (DPSS) and Z-suture technique following MitraClip procedure.

Methods: Between 01/2014 and 12/2017, all consecutive patients who underwent MitraClip procedure at our institution were included. Closure of the femoral vein access was performed using DPSS technique or Z-suture. Primary endpoint was access site related vascular complications according to Valve Academic Research Consortium (VARC-2) criteria, secondary endpoints were access related surgical therapy, access related bleeding and in-hospital mortality.

Results: 249 patients (165 male, 76±8years) were included. Closure of femoral vein access was performed using Z-Suture technique in 140 patients, whereas DPSS technique was used in 109 patients. Access site related VARC-2 minor and major complications were comparable after closure with Z-suture and DPSS-technique (4.3% vs 0.9%, p=0.111 and 1.4% vs 0.9%, p= 0.714, respectively). However, development of AV-fistula and requirement of access related surgical intervention was more observed in Z-suture group compared to DPSS group (5% vs 0%, p=0.018 and 3.5% vs 0%, p=0.045, respectively).

Conclusion: Large calibre venous access closure with subcutaneous absorbable DPSS technique was feasible, safe and effective to achieve immediate homeostasis after MitraClip procedure with less required access related surgical therapy compared to Z-suture technique.
Table. In-hospital clinical outcome