Supplementary Material for: A Comparison of two Vascular Closure Strategies in Transcatheter Aortic Valve Replacement: Suture and Plug versus Suture alone: A Systematic Review and Meta-Analysis

Introduction:
Vascular complications following transcatheter aortic valve replacement (TAVR) significantly contribute to morbidity and mortality. Conventional suture‐based closure technique has been widely utilized for large‐bore arterial access closure. Recent findings on hybrid strategy combining plug and suture‐based devices has been on spotlight as it may improve the hemostatic efficacy and lower the access-site related complications and clinical outcomes.
Methods:
We performed a systematic review and meta‐analysis of studies comparing a suture‐based approach with a hybrid closure strategy (suture+plug) in aortic stenosis patients undergoing TAVR. Included studies were appraised following the Cochrane Risk of Bias and Newcastle-Ottawa Scale tools. Forest plots were extracted in Review Manager with a main outcome of pooled-risk ratio (RR). The primary endpoint was the composite of access‐site related vascular complications as defined by Valve Academic Research Consortium criteria whilst secondary end-points were in-hospital bleeding, closure device failure, mortality and unplanned endovascular or surgical intervention
Results:
Six eligible studies encompassing 2,064 patients were analyzed. Compared with suture‐based closure, hybrid closure exhibited a lower rate of vascular complications [pooled-RR 0.46; 95% CI, 0.38–0.57; p <0.001], closure device failure [pooled-RR 0.35; 95% CI, 0.13–0.96; p=0.04], in-hospital bleeding events [pooled-RR 0.38; 95% CI, 0.26–0.55; p <0.001] and mortality [pooled-RR 0.51; 95% CI, 0.26–0.99; p=0.049]. Unplanned endovascular or surgical intervention was no different among two groups [pooled-RR 0.42; 95% CI, 0.17–1.06; p=0.07].
Conclusion:
Hybrid vascular closure strategy offers better efficacy with lesser complications amongst patients undergoing TAVR, directing the clinical adoption of hybrid techniques, although further large‐scale multicenter studies are warranted to confirm the benefit and optimize patient selection.