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Figure-of-eight suture combined with a three-way stopcock for venous closure following left atrial appendage occlusion or patent foramen ovale closure

Camilla Westergaard Rasmussen, Kasper Korsholm, Anders Kramer, Jens Erik Nielsen-Kudsk, Asger Andersen

Background: No guidelines exist regarding venous access site closure after catheterbased procedures. This study aimed to compare standard figure-of-eight suture with a modified version tightened by a three-way-stopcock with regards to postprocedural bleeding incidence, bleeding duration, time to ambulation and possible predictors of bleeding.

Methods and findings: A prospective cohort study of consecutive patients undergoing left atrial appendage occlusion or patent foramen ovale closure between April 2019 and October 2020 (n=208). A standard figure-of-eight suture closed with a surgical knot was applied in the first 103 patients and a three-way-stopcock was used to close the figure-of-eight suture in the subsequent 105 patients. Study outcomes were any postprocedural bleeding, duration of bleeding and time to ambulation. Bleeding was categorized as minor if time to ambulation was unchanged, moderate if time was prolonged or severe if the bleeding required intervention (transfusion or surgery).

Results: A total of 208 patients were included. Any bleeding occurred in 77 patients (75.5%) in the standard-group and 79 patients (75.2%) in the stopcock-group, p=0.97. Moderate bleeding occurred in 39 (37.9%) and 40 (38.1%) patients in the standard versus stopcock-group, respectively, p=0.99. In patients with moderate bleeding, median bleeding duration was 296 min (IQR: 195-555) in the standard group and 195 min (IQR: 87.5-302.5) in the stopcock group, p<0.01. Time to ambulation did not significantly differ between the groups (120 min vs. 90 min, p=0.31). No predictors of bleeding were identified.

Conclusion: A three-way-stopcock to secure the figure-of-eight suture did not reduce bleeding incidence, but bleeding duration was reduced in patients with moderate bleeding. Data must be confirmed by larger randomized studies.