A unilateral, suture-based dry-closure technique facilitates safe and effective access management in high-risk patients selected for percutaneous Trans-axillary transcatheter aortic valve implantation (TAx-TAVI) procedures, new data suggests. Speaking in a late-breaking Out of the Box Studies session at Cardiovascular Research Technologies (CRT) 2025 on Sunday, Rutger-Jan Nuis, MD, PhD, from the Erasmus University Medical Center in Rotterdam, the Netherlands, noted that TAx-TAVI is the most used alternative access when severe iliofemoral disease renders trans-femoral access infeasible. “Compared to surgical transaxillary access, a true percutaneous approach using vascular closure devices (VCD) has advantages but can be challenging,” he said. Study details Dr. Nuis and colleagues assessed the effect of a unilateral, suture-mediated, dry-closure technique on vascular safety in 77 patients undergoing true percutaneous TAx-TAVI. Patients were categorized into a cohort before (C1, n=40) and after (C2, n=37) implementation of the suture-based dry-closure technique using an upstream occlusion balloon, said Dr. Nuis, noting that in the C1 cohort, arteriotomy closure mainly consisted of plug-based VCD. The mean age of the study population was 79 years and 49% were male, and the primary endpoint was the occurrence of major or minor access-site related vascular complications, he said. From C1 to C2, the Society of Thoracic Surgeons (STS) Predicted Risk of Mortality reduced numerically (from 4.1 to 3.6%, p=0.060) while the procedure itself became more streamlined with local anesthesia used in 100% of the patients (C1: 83%) and access via the left axillary artery in 76% (C1: 68%). “The primary endpoint occurred in 34% of the patients, but reduced from 45% in C1 to 16% in C2 (p=0.011),” Dr. Nuis said, noting a concurrent reduction in VCD failure (45 vs 14% [incomplete arteriotomy closure in all 5 cases], p=0.003), bleeding complications (45 vs 14%, p=0.003) and bailout vascular surgery/stenting (40% vs. 16%, p=0.021). Furthermore, the median length of hospital stay was reduced from 5 to 3 days (p=0.080), he revealed. “The unilateral, suture-based dry-closure technique facilitates safe and effective access management in high-risk patients selected for percutaneous TAx-TAVI procedures,” Dr. Nuis concluded. Image Credit: Bailey G. Salimes Image Caption: Rutger-Jan Nuis, MD, PhD, presents during the Late-Breaking Out of the Box Studies session at Cardiovascular Research Technologies (CRT) 2025 on Sunday.