{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T20:39:15Z","timestamp":1791319155741,"version":"4.3.1"},"reference-count":26,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,7,25]],"date-time":"2025-07-25T00:00:00Z","timestamp":1753401600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Percutaneous mitral valve repair using the MitraClip System is a well-established therapeutic option for patients with symptomatic mitral regurgitation. This procedure is usually performed via venous femoral access using a 24-French guiding catheter. Since vascular complications and bleeding remain a relevant limitation, we now compared access closure using subcutaneous absorbable double purse string suture (DPSS) and Z-suture technique following MitraClip procedure.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>249 patients (mean age 76\u2009\u00b1\u20098 years) who underwent MitraClip procedure at our institution were included. Venous closure was performed using Z-suture technique in 140 patients and DPSS technique in 109 patients. Vascular complications and bleeding events were assessed according to the Mitral Valve Academic Research Consortium (MVARC) criteria.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>MVARC minor and major vascular complications were comparable after closure with Z-suture and DPSS-technique (4.3% vs. 0.9%, <jats:italic>p<\/jats:italic>\u2009=\u20090.11 and 1.4% vs. 0.9%, <jats:italic>p<\/jats:italic>\u2009=\u20090.71, respectively). However, development of AV-fistula and requirement of access related surgical intervention was more often observed in the Z-suture group (5% vs. 0%, <jats:italic>p<\/jats:italic>\u2009=\u20090.018 and 3.5% vs. 0%, <jats:italic>p<\/jats:italic>\u2009=\u20090.045). MVARC minor and major, non-life-threatening bleeding did not differ between the two groups (10.7% vs. 12.9%, <jats:italic>p<\/jats:italic>\u2009=\u20090.61 and 0.7% vs. 0.0%, <jats:italic>p<\/jats:italic>\u2009=\u20090.38). Similarly, overall transfusion rates and access related blood transfusion rates were comparable (11.4% vs. 15.5%, <jats:italic>p<\/jats:italic>\u2009=\u20090.34 and 4.3% vs. 2.7%, <jats:italic>p<\/jats:italic>\u2009=\u20090.52).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Large caliber venous access closure with DPSS technique was feasible, safe, and effective to achieve haemostasis after MitraClip procedure. Compared with Z-suture, use of DPSS closure was associated with a lower rate of required access related surgical intervention and postinterventional AV-fistula.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcvm.2025.1585522","type":"journal-article","created":{"date-parts":[[2025,7,25]],"date-time":"2025-07-25T05:25:35Z","timestamp":1753421135000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Comparison of safety and efficacy in venous access closure using a double purse string suture technique vs. Z-suture technique after MitraClip procedure"],"prefix":"10.3389","volume":"12","author":[{"given":"Anas","family":"Alnaimi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian 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