VASCADE MVP-XL Versus VASCADE MVP for Large-Bore Venous Access-Site Closure in Electrophysiology Procedures: A Single-Center Experience on Efficacy and Complications.

INTRODUCTION:Vascular closure devices, used for the percutaneous closure of the femoral venous access-sites following electrophysiology (EP) procedures, are known to require shorter time to hemostasis compared to manual compression. The new VASCADE MVP_XL (Haemonetics Corp., USA) was designed for procedures utilizing large procedural sheaths, with a resorbable patch with 58% higher collagen content than the earlier VASCADE-MVP system, for better efficacy. OBJECTIVE:We aimed to compare the safety and efficacy of VASCADE MVP-XL and VASCADE MVP in consecutive patients with atrial fibrillation (AF) undergoing procedures utilizing large sheaths (i.e. Farapulse pulsed-field ablation and left atrial appendage closure procedure). METHODS:Based on the device used to achieve access-site hemostasis, AF patients undergoing EP procedures were classified into group 1: MVP-XL (n = 151) and group 2: MVP (n = 423). The closure device was deployed under ultrasound guidance and included 2-4 min of gentle compression followed by approximately 2 h of bedrest. Fluoroscopy was used for proper positioning and accurate deployment of the collagen patch. All procedures were conducted under uninterrupted anticoagulation. The access-sites were examined immediately after the procedure, after the 2 h bed-rest and before discharge. RESULTS:Baseline characteristics were similar between the groups except the procedure type (Watchman) and rivaroxaban use. Time to final sheath pull, time to ambulation and time to discharge were similar between the groups. Access-site bleeding occurred in 13 patients (3.1%) in the MVP group versus none (0%) in the MVP-XL group (p = 0.029). Time to hemostasis was significantly shorter in the MVP-XL group. CONCLUSION:VASCADE MVP-XL has a better safety and efficacy profile compared to the VASCADE-MVP system, especially in procedures involving large sheaths.