Читать книгу Interventional Cardiology - Группа авторов - Страница 60

The MANTA™ vascular closure device (Essential Medical, Exton, PA) is a collagen‐based closure device (Figure 2.8). It is intended to directly close large bore accesses at the end of the procedure, without pre‐closure, and is compatible with an 0.035‐inch guidewire. The system consists of a poly‐lactic‐co‐glycolic component (toggle) attached to a collagen plug and a delivery system used to place the toggle‐collagen plug implant. The toggle is deployed within the artery while the bovine collagen plug remains outside the vessel wall. A stainless‐steel lock is tampered down pushing the collagen and toggle together in order to sandwich the arterial puncture site between the toggle and the collagen. The proper amount of tension that the operator has to apply is indicated by the appearance of a green marker on the device handle. The radiopaque lock is visible under angiography and is a helpful landmark for future interventions. The toggle and collagen plug resolve completely in 6 months. Recommended re‐access point is 2.5 cm above or below the existing MANTA Device. The device comes in two sizes: 14 Fr and 18 Fr for arteriotomy closure between 10 and 14 Fr and 14 and 22 Fr, respectively. MANTA has also been applied for completely percutaneous closure of axillary arteriotomies after TAVI.

Figure 2.8 MANTA device. A bovine collage pad in grey seals the arteriotomy from the outside of the vessel and is connected with the endoluminal bioresorbable toggle through a suture that is closed by a stainless‐steel suture lock.

The available preliminary results report a successful implant in 100% of patients, with a mean time to haemostasis of 2 min and 23 sec and a good safety profile [30].