Vascular closure with a suture retention device versus suture-mediated closure system after large bore venous access for electrophysiologic procedures.

BACKGROUND: The LockeT is a suture retention device that may be a postoperative closure option for electrophysiologic procedures requiring large-bore vascular access (LBVA) but warrants further evaluation. OBJECTIVES: We compare the use of LockeT to a suture-mediated vascular closure device for LBVA after left atrial appendage occlusion (LAAO). METHODS: We performed a retrospective study of LBVA after LAAO from March 2023 to August 2024 using LockeT or Perclose ProGlide. Endpoints included access-site-related complications, time to hemostasis (TTH), time to ambulation (TTA), and same-day discharge (SDD). RESULTS: We identified 208 patients (n) who underwent either LockeT (n = 86; N = 172) or Perclose (n = 122; N = 362) devices. Even after propensity score matching (LockeT: n = 86; and Perclose: n = 86), those undergoing LockeT had few differences in baseline characteristics and were associated with more frequent Amulet (62.8% vs. 16.3%) than Watchman (37.2% vs. 68.6%) LAAO implantation. The LockeT was associated with no difference in TTH (20 [interquartile range (IQR) 7.0-103.0] vs. 18.0 [IQR 8.0-66.0] min, p = 0.833) and higher TTA (4.3 [IQR 3.7-5.1] vs. 2.9 [2.5-4.1] hours, p < 0.001). There were fewer cumulative access-site complications (1.2% vs. 9.3%, p = 0.017) and device failures (0.0% vs. 4.7%, p = 0.023), and similar same-day discharges (84.9% vs. 87.2%, p = 0.66). CONCLUSIONS: The two devices have similar hemostasis outcomes for LBVA following LAAO, but each has unique considerations. LockeT was associated with fewer access-site complications and device failures; Perclose was associated with faster TTA. Nevertheless, additional studies are still needed.