A tissue access site system and methods for opening and closing a tissue access site are provided. A method for opening and closing an access site in a body lumen includes attaching a plurality of closure elements to a perimeter wall of a body lumen by advancing closure elements from an access and closure device associated with a guide wire positioned through the perimeter wall. A tissue cutting element of the access and closure device is advanced along the guide wire to cause the tissue cutting element to penetrate through the perimeter wall to open an access site in the perimeter wall that includes a plurality of tissue flaps. Each of the tissue flaps has a predetermined geometry and is attached to at least one of the closure elements. The closure elements are used to close the access site.
