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Yazdani SK, Shedd O, Christy G, Teeslink R. A Novel Suture-Based Vascular Closure Device to Achieve Hemostasis after Venous or Arterial Access While Leaving Nothing behind: A Review of the Technological Assessment and Early Clinical Outcomes. J Clin Med 2024; 13:4606. [PMID: 39200748 PMCID: PMC11354790 DOI: 10.3390/jcm13164606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 07/26/2024] [Accepted: 08/03/2024] [Indexed: 09/02/2024] Open
Abstract
Vascular hemostasis after venous and arterial access in cardiovascular procedures remains a challenge. As sheath size gets larger for structural heart and vascular procedures, no dedicated closure devices exist that can overcome all the challenges of achieving vascular hemostasis, in particular on the venous side. Efficiently and reliably ensuring hemostasis at the access point is crucial for enhancing the safety of a procedure. Historically, hemostasis relied on manually compressing venous access sites. However, the shift towards larger sheaths and the more frequent use of continuous anticoagulation has strained this approach. Achieving hemostasis solely through compression in these scenarios demands heightened vigilance and prolonged application, resulting in increased patient discomfort and extended immobility. Consequently, manual compression may consume more time for healthcare providers and contribute to bed occupancy in hospitals. This review article summarizes the development of the SiteSeal® Vascular Closure Device, a novel leave-nothing-behind approach to achieve hemostasis. The introduction of this technology has provided clinicians with a safer and more effective way to achieve immediate hemostasis, facilitate early ambulation, and enable earlier discharges with fewer access site complications compared with traditional manual compression.
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Affiliation(s)
- Saami K. Yazdani
- Department of Engineering, Wake Forest University, Winston-Salem, NC 27101, USA
| | - Omer Shedd
- Department of Cardiology and Electrophysiology, CaroMont Regional Medical Center, Gastonia, NC 28054, USA;
| | - George Christy
- Department of Interventional Cardiology, Advocate Good Shepherd Hospital, Barrington, IL 60010, USA;
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Katapadi A, Pham N, Chelikam N, Ghazal R, Mansabdar A, Ehteshamuddin F, Darden D, Gopinathannair R, Kabra R, Pothineni NV, Bommana S, Atkins D, DiBiase L, Al-Ahmad A, Natale A, Lakkireddy D. Feasibility, safety, and efficacy of a novel external compression vascular closure device: The LockeT® study. J Cardiovasc Electrophysiol 2024. [PMID: 39099135 DOI: 10.1111/jce.16381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 07/08/2024] [Accepted: 07/17/2024] [Indexed: 08/06/2024]
Abstract
INTRODUCTION Hemostasis following large-bore femoral vein access remains a challenge. Manual compression has been the standard of care but requires bedside staff, prolonged bed rest, and longer length of stay. The LockeT is an external compression device that attempts to address these issues while achieving venous hemostasis. OBJECTIVES We evaluate postprocedural hemostasis and vascular closure outcomes after using LockeT following cardiac electrophysiologic procedures. METHODS We performed a single-center, observational study of patients who underwent vascular closure for electrophysiology procedures using LockeT. Postprocedural outcomes were subsequently analyzed. RESULTS We studied 102 patients (N) for whom LockeT was used to close 182 separate vascular access sites (n). Common procedures were atrial fibrillation ablation (56.9%, N = 58) and left atrial appendage occlusion (28.4%, N = 29). Most often, 8-Fr [48.3% (n = 126)], 11-Fr [27.2% (n = 71)], and 8.5-Fr [16.9% (n = 44)] sheaths were used, with an average procedure time of 82.1 ± 29.4 min. Hemostasis was achieved in 97.8% (n = 187) of all LockeT cases. Time to ambulation and discharge were 3.93 ± 1.10 h and 8.1 ± 4.4 h, respectively. No major complications were noted. Postprocedurally, 52% (N = 53) of patients were discharged on the same day. There were no differences in hemostasis (p = .859) or ambulation times (p = .202) between procedure types. CONCLUSION The LockeT can effectively close venous access sites with no major complications.
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Affiliation(s)
| | - Nicholas Pham
- Kansas City Heart Rhythm Institute, Overland Park, Kansas, USA
| | | | - Rachad Ghazal
- Kansas City Heart Rhythm Institute, Overland Park, Kansas, USA
| | | | | | - Douglas Darden
- Kansas City Heart Rhythm Institute, Overland Park, Kansas, USA
| | | | - Rajesh Kabra
- Kansas City Heart Rhythm Institute, Overland Park, Kansas, USA
| | | | | | - Donita Atkins
- Kansas City Heart Rhythm Institute, Overland Park, Kansas, USA
| | - Luigi DiBiase
- Department of Cardiology, Montefiore Medical Center, Bronx, New York, USA
| | - Amin Al-Ahmad
- Texas Cardiac Arrhythmia Institute, Austin, Texas, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, Austin, Texas, USA
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3
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Parikh RV, Tehrani DM, Seto AH. Suture-Mediated Vascular Closure for Intermediate-Bore Femoral Venous Access. JACC Clin Electrophysiol 2024; 10:1837-1839. [PMID: 39197969 DOI: 10.1016/j.jacep.2024.05.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Accepted: 05/02/2024] [Indexed: 09/01/2024]
Affiliation(s)
- Rushi V Parikh
- Division of Cardiology, University of California-Los Angeles, Los Angeles, California, USA.
| | - David M Tehrani
- Stanford Health Care Tri-Valley, Pleasanton, California, USA. https://twitter.com/davidtehrani3
| | - Arnold H Seto
- VA Long Beach Healthcare System, Long Beach, California, USA. https://twitter.com/arnoldseto
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Mills MT, Calvert P, Lip GYH, Luther V, Gupta D. Outcomes of vascular closure devices for femoral venous hemostasis following catheter ablation of atrial fibrillation. J Cardiovasc Electrophysiol 2024; 35:1656-1662. [PMID: 38924288 DOI: 10.1111/jce.16345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 05/21/2024] [Accepted: 06/06/2024] [Indexed: 06/28/2024]
Abstract
INTRODUCTION Access site complications remain common following atrial fibrillation (AF) catheter ablation. Femoral vascular closure devices (VCDs) reduce time to hemostasis compared with manual compression, although large-scale data comparing clinical outcomes between the two approaches are lacking. METHODS Two cohorts of patients undergoing AF ablation were identified from 36 healthcare organizations using a global federated research network (TriNetX): those receiving a VCD for femoral hemostasis, and those not receiving a VCD. A 1:1 propensity score matching (PSM) model based on baseline characteristics was used to create two comparable cohorts. The primary outcome was a composite of all-cause mortality, vascular complications, bleeding events, and need for blood transfusion. Outcomes were assessed during early (within 7 days of ablation) and extended follow-up (within 8-30 days of ablation). RESULTS After PSM, 28 872 patients were included (14 436 in each cohort). The primary composite outcome occurred less frequently in the VCD cohort during early (1.97% vs. 2.60%, odds ratio (OR) 0.76, 95% confidence interval (CI) 0.65-0.88; p < .001) and extended follow-up (1.15% vs. 1.43%, OR 0.80, 95% CI 0.65-0.98; p = .032). This was driven by a lower rate of vascular complications during early follow-up in the VCD cohort (0.83% vs. 1.26%, OR 0.66, 95% CI 0.52-0.83; p < .001), and fewer bleeding events during early (0.90% vs. 1.23%, OR 0.73, 95% CI 0.58-0.92; p = .007) and extended follow-up (0.36% vs. 0.59%, OR 0.61, 95% CI 0.43-0.86; p = .005). CONCLUSION Following AF ablation, femoral venous hemostasis with a VCD was associated with reduced complications compared with hemostasis without a VCD.
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Affiliation(s)
- Mark T Mills
- Department of Cardiology, Liverpool Heart & Chest Hospital, Liverpool, UK
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Peter Calvert
- Department of Cardiology, Liverpool Heart & Chest Hospital, Liverpool, UK
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Gregory Y H Lip
- Department of Cardiology, Liverpool Heart & Chest Hospital, Liverpool, UK
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Department of Clinical Medicine, Danish Center for Health Services Research, Aalborg University, Aalborg, Denmark
| | - Vishal Luther
- Department of Cardiology, Liverpool Heart & Chest Hospital, Liverpool, UK
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Dhiraj Gupta
- Department of Cardiology, Liverpool Heart & Chest Hospital, Liverpool, UK
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
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Chikata A, Kato T, Usuda K, Fujita S, Usuda K, Maruyama M, Otowa KI, Kusayama T, Tsuda T, Hayashi K, Takamura M. Preclose Versus Postclose Using Suture-Mediated Vascular Closure System for Catheter Ablation With Femoral Vein Access. JACC Clin Electrophysiol 2024; 10:1828-1836. [PMID: 38795098 DOI: 10.1016/j.jacep.2024.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 03/27/2024] [Accepted: 03/31/2024] [Indexed: 05/27/2024]
Abstract
BACKGROUND Differences in the efficacy and safety between the preclose and postclose suture-mediated vascular closure systems for femoral vein access have not been adequately studied. OBJECTIVES This study aimed to evaluate the efficacy and safety of these 2 suturing techniques in femoral vein access. METHODS Patients subjected to elective catheter ablation via the femoral vein using a sheath of 8- to 13-F inner diameter (n = 282) were randomized to the preclose or postclose groups for the single-suture technique using ProGlide/ProStyle (Abbott Vascular). Duplex ultrasound was performed on days 1 and 90 after the procedure to evaluate vascular complications. The primary efficacy endpoint was rebleeding requiring recompression, and the primary safety endpoint was any major complication occurring within 90 days. The secondary efficacy endpoints included time to hemostasis and time to ambulation, and the secondary safety endpoint was any minor complication occurring within 90 days. RESULTS The preclose group demonstrated a significantly lower rebleeding rate (5 of 141 [3.5%] vs 15 of 141 [10.6%]; P = 0.03) and shorter time to hemostasis (254.0 ± 120.4 seconds vs 299.8 ± 208.2 seconds; P = 0.02) compared with the postclose group. Five patients in each group were lost to follow-up at 90 days. Incidence of major complications were similar in both groups (1 of 136 [0.7%]; P = 1.00), whereas minor complications were observed in 18 of 136 (13.2%) and 21 of 136 (15.4%) patients in the preclose and postclose groups, respectively, without a significant difference (P = 0.73). CONCLUSIONS In femoral vein access using the single-suture technique with ProGlide/ProStyle, the preclose technique presented a higher hemostasis rate than the postclose technique, without compromising safety.
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Affiliation(s)
- Akio Chikata
- Department of Cardiology, Toyama Prefectural Central Hospital, Toyama, Japan; Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Takeshi Kato
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan.
| | - Kazuo Usuda
- Department of Cardiology, Toyama Prefectural Central Hospital, Toyama, Japan
| | - Shuhei Fujita
- Department of Pediatrics, Toyama Prefectural Central Hospital, Toyama, Japan
| | - Keisuke Usuda
- Department of Cardiology, Toyama Prefectural Central Hospital, Toyama, Japan
| | - Michiro Maruyama
- Department of Cardiology, Toyama Prefectural Central Hospital, Toyama, Japan
| | - Kan-Ichi Otowa
- Department of Cardiology, Toyama Prefectural Central Hospital, Toyama, Japan
| | - Takashi Kusayama
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Toyonobu Tsuda
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Kenshi Hayashi
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Masayuki Takamura
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
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Tilz RR, Feher M, Vogler J, Bode K, Duta AI, Ortolan A, Lopez LD, Küchler M, Mamaev R, Lyan E, Sommer P, Braun M, Sciacca V, Demming T, Maslova V, Kuck KH, Heeger CH, Eitel C, Popescu SS. Venous vascular closure system vs. figure-of-eight suture following atrial fibrillation ablation: the STYLE-AF Study. Europace 2024; 26:euae105. [PMID: 38647070 PMCID: PMC11210072 DOI: 10.1093/europace/euae105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 04/09/2024] [Indexed: 04/25/2024] Open
Abstract
AIMS Simplified ablation technologies for pulmonary vein isolation (PVI) are increasingly performed worldwide. One of the most common complications following PVI are vascular access-related complications. Lately, venous closure systems (VCSs) were introduced into clinical practice, aiming to reduce the time of bed rest, to increase the patients' comfort, and to reduce vascular access-related complications. The aim of the present study is to compare the safety and efficacy of using a VCS to achieve haemostasis following single-shot PVI to the actual standard of care [figure-of-eight suture and manual compression (MC)]. METHODS AND RESULTS This is a prospective, multicentre, randomized, controlled, open-label trial performed at three German centres. Patients were randomized 1:1 to undergo haemostasis either by means of VCS (VCS group) or of a figure-of-eight suture and MC (F8 group). The primary efficacy endpoint was the time to ambulation, while the primary safety endpoint was the incidence of major periprocedural adverse events until hospital discharge. A total of 125 patients were randomized. The baseline characteristics were similar between the groups. The VCS group showed a shorter time to ambulation [109.0 (82.0, 160.0) vs. 269.0 (243.8, 340.5) min; P < 0.001], shorter time to haemostasis [1 (1, 2) vs. 5 (2, 10) min; P < 0.001], and shorter time to discharge eligibility [270 (270, 270) vs. 340 (300, 458) min; P < 0.001]. No major vascular access-related complication was reported in either group. A trend towards a lower incidence of minor vascular access-related complications on the day of procedure was observed in the VCS group [7 (11.1%) vs. 15 (24.2%); P = 0.063] as compared to the control group. CONCLUSION Following AF ablation, the use of a VCS results in a significantly shorter time to ambulation, time to haemostasis, and time to discharge eligibility. No major vascular access-related complications were identified. The use of MC and a figure-of-eight suture showed a trend towards a higher incidence of minor vascular access-related complications.
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Affiliation(s)
- Roland Richard Tilz
- Department of Rhythmology, University Heart Center Lübeck, University Clinic Schleswig-Holstein, Ratzeburger Allee 160, D-23538 Luebeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Luebeck, Germany
| | - Marcel Feher
- Department of Rhythmology, University Heart Center Lübeck, University Clinic Schleswig-Holstein, Ratzeburger Allee 160, D-23538 Luebeck, Germany
| | - Julia Vogler
- Department of Rhythmology, University Heart Center Lübeck, University Clinic Schleswig-Holstein, Ratzeburger Allee 160, D-23538 Luebeck, Germany
| | - Kerstin Bode
- Department of Rhythmology, Heart Center of Leipzig, Leipzig, Germany
| | - Alexandru Ionut Duta
- Department of Rhythmology, University Heart Center Lübeck, University Clinic Schleswig-Holstein, Ratzeburger Allee 160, D-23538 Luebeck, Germany
| | - Angela Ortolan
- Department of Rhythmology, University Heart Center Lübeck, University Clinic Schleswig-Holstein, Ratzeburger Allee 160, D-23538 Luebeck, Germany
| | - Lisbeth Delgado Lopez
- Department of Rhythmology, University Heart Center Lübeck, University Clinic Schleswig-Holstein, Ratzeburger Allee 160, D-23538 Luebeck, Germany
| | - Mirco Küchler
- Department of Rhythmology, University Heart Center Lübeck, University Clinic Schleswig-Holstein, Ratzeburger Allee 160, D-23538 Luebeck, Germany
| | - Roman Mamaev
- Department of Rhythmology, University Heart Center Lübeck, University Clinic Schleswig-Holstein, Ratzeburger Allee 160, D-23538 Luebeck, Germany
| | - Evgeny Lyan
- Department of Internal Medicine III, University Medical Center of Schleswig-Holstein—Campus Kiel, Kiel, Germany
| | - Philipp Sommer
- Department of Electrophysiology and Rhythmology, Herz- und Diabeteszentrum NRW, Ruhr-Universitaet Bochum, Bad Oeynhausen, Germany
| | - Martin Braun
- Department of Electrophysiology and Rhythmology, Herz- und Diabeteszentrum NRW, Ruhr-Universitaet Bochum, Bad Oeynhausen, Germany
| | - Vanessa Sciacca
- Department of Electrophysiology and Rhythmology, Herz- und Diabeteszentrum NRW, Ruhr-Universitaet Bochum, Bad Oeynhausen, Germany
| | - Thomas Demming
- Department of Internal Medicine III, University Medical Center of Schleswig-Holstein—Campus Kiel, Kiel, Germany
| | - Vera Maslova
- Department of Internal Medicine III, University Medical Center of Schleswig-Holstein—Campus Kiel, Kiel, Germany
| | - Karl-Heinz Kuck
- Department of Rhythmology, University Heart Center Lübeck, University Clinic Schleswig-Holstein, Ratzeburger Allee 160, D-23538 Luebeck, Germany
| | - Christian-Hendrik Heeger
- Department of Rhythmology, University Heart Center Lübeck, University Clinic Schleswig-Holstein, Ratzeburger Allee 160, D-23538 Luebeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Luebeck, Germany
| | - Charlotte Eitel
- Department of Rhythmology, University Heart Center Lübeck, University Clinic Schleswig-Holstein, Ratzeburger Allee 160, D-23538 Luebeck, Germany
| | - Sorin Stefan Popescu
- Department of Rhythmology, University Heart Center Lübeck, University Clinic Schleswig-Holstein, Ratzeburger Allee 160, D-23538 Luebeck, Germany
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Tachi M, Tanaka A, Teraoka T, Furuta T, Matsushita E, Hayashi K, Shimojo M, Yanagisawa S, Inden Y, Murohara T. Feasibility and efficacy of real-time ultrasound-guided venous closure with suture-mediated vascular closure device. Heart Rhythm 2024:S1547-5271(24)02368-3. [PMID: 38608918 DOI: 10.1016/j.hrthm.2024.04.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 04/05/2024] [Accepted: 04/07/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND Venous vascular access complications are usually nonfatal but are the most common complications after transvenous catheter intervention. Vascular closure devices (VCDs) have recently become available for venous closure. OBJECTIVE This study aimed to evaluate the feasibility and efficacy of real-time ultrasound-guided venous closure with suture-mediated VCDs in patients who underwent catheter ablation. METHODS This single-center observational study enrolled 226 consecutive patients who underwent elective catheter ablation with femoral venipuncture. For hemostasis, vessel closure by VCD was performed with real-time ultrasound guidance after 2022 (n = 123) and without ultrasound guidance in 2021 (n = 103). The occurrence of venous access site-related complications (major, minor, or other) was compared. RESULTS The rate of device failure was significantly lower in patients with ultrasound guidance than in those without (1.6% vs 6.3%; P = .048). The occurrence of all venous access site-related complications was significantly lower in patients with ultrasound guidance than in those without (4.9% vs 18.4%; P = .001). Time to ambulation was shorter in patients with ultrasound guidance than in those without (2.0 ± 0.1 hours vs 2.2 ± 0.6 hours; P < .001). CONCLUSION Real-time ultrasound guidance can reduce device failure, access site-related complications, and time to ambulation in performing venous closure with a VCD.
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Affiliation(s)
- Masaya Tachi
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Cardiology, Nakatugawa Municipal Hospital, Nakatugawa, Japan
| | - Akihito Tanaka
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Tsubasa Teraoka
- Department of Cardiology, Nakatugawa Municipal Hospital, Nakatugawa, Japan
| | - Tappei Furuta
- Department of Cardiology, Nakatugawa Municipal Hospital, Nakatugawa, Japan
| | - Etsushi Matsushita
- Department of Cardiology, Nakatugawa Municipal Hospital, Nakatugawa, Japan
| | - Kazunori Hayashi
- Department of Cardiology, Nakatugawa Municipal Hospital, Nakatugawa, Japan
| | - Masafumi Shimojo
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Satoshi Yanagisawa
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuya Inden
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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8
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Gupta S, Kolluri R, Simoes T, Pingle SC, Nie H, Lloyd MS, Steinhaus D, Westerman SB, Shah A, Kline J, Kiani S. Safety of multi-access site venous closure following catheter ablation of atrial fibrillation and flutter. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01773-3. [PMID: 38413483 DOI: 10.1007/s10840-024-01773-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 02/12/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND Following catheter ablation, vascular access management involves potential complications and prolonged recovery. Recently, suture-mediated closure (SMC) devices were approved for venous access procedures. The objective of this study is to evaluate the safety of a commercially available SMC for multiple access site venous closure by duplex ultrasound (DUS) in asymptomatic subjects with non-visible complications. METHODS Thirty-six subjects (63 ± 10.7 years old, 12 female) were enrolled. Following catheter ablation for atrial fibrillation, all subjects had SMC of every venous access site. Subjects underwent DUS of femoral veins and arteries. DUS was performed at discharge, and again at 30 days. Subjects were evaluated for clinically apparent vascular complications. RESULTS Mean procedure duration was 138.6 min, and the time to hemostasis was 3.1 min/access site and 9.5 min/subject. Median time to ambulation was 193.5 min, and median time to discharge was 5.95 h, with discharge as early as 2.4 h. A median of 2 sheaths/vein and a median of 2 SMC devices/vein were used. There were no major complications and a 16.7% (6/36) minor complication rate at discharge. All complications resolved at 30 days. The complication rate was not higher in patients with 2 SMC per access site as compared to the patients who just received 1 SMC per access site. CONCLUSIONS This study demonstrates the safety of multi-access closure using SMC, following catheter ablation procedures, for closure of sites that use sheath sizes from ≤ 8F to ≥ 15F and for those that use 2 or more SMCs per access site.
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Affiliation(s)
- Sanjaya Gupta
- Division of Cardiology, Saint Luke's Mid-America Heart Institute, 9th Floor, Cardiovascular Research, Kansas City, MO, 64111, USA.
- University of Missouri Kansas City School of Medicine, Kansas City, MO, USA.
| | | | | | | | - Hong Nie
- Abbott Vascular, Santa Clara, CA, USA
| | | | - Daniel Steinhaus
- Division of Cardiology, Saint Luke's Mid-America Heart Institute, 9th Floor, Cardiovascular Research, Kansas City, MO, 64111, USA
- University of Missouri Kansas City School of Medicine, Kansas City, MO, USA
| | | | - Anand Shah
- Division of Cardiology, Emory University, Atlanta, GA, USA
| | - Jessica Kline
- Division of Cardiology, Saint Luke's Mid-America Heart Institute, 9th Floor, Cardiovascular Research, Kansas City, MO, 64111, USA
- University of Missouri Kansas City School of Medicine, Kansas City, MO, USA
| | - Soroosh Kiani
- Division of Cardiology, Emory University, Atlanta, GA, USA
- Division of Cardiovascular Medicine, UMass Chan Medical School, Worcester, MA, USA
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9
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Ikenouchi T, Takigawa M, Goya M, Kudo T, Sasano T. Refractory Deep Vein Thrombosis Caused by Femoral Vein Stenosis Due to Suture-Medicated Vascular Closure Device. Int J Angiol 2023; 32:288-291. [PMID: 37927830 PMCID: PMC10624525 DOI: 10.1055/s-0042-1751230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Vascular closing devices (VCDs) are widely used to replace manual compression at the femoral puncture site after catheter insertion. Perclose ProGlide is a suture-medicated VCD that is indicated for both arterial and venous access sites. However, there are few reports of complications related to venous use of ProGlide. Here, we describe a case of femoral vein stenosis caused by a suture-medicated VCD after an ablation procedure, which developed refractory deep vein thrombosis even after surgical vascular repair.
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Affiliation(s)
- Takashi Ikenouchi
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masateru Takigawa
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masahiko Goya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toshifumi Kudo
- Department of Peripheral Vascular Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
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10
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Sairaku A, Hashimoto K, Nakano Y. A Novel Hemostatic Belt Allowing Ambulation Soon After Atrial Fibrillation Ablation. J Cardiovasc Transl Res 2023; 16:1439-1446. [PMID: 37526899 DOI: 10.1007/s12265-023-10417-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 07/21/2023] [Indexed: 08/02/2023]
Abstract
We aimed to develop a hemostatic device with physiological evidence that allows ambulation soon after atrial fibrillation (AF) ablation. We measured right femoral vein pressure in 57 participants to clarify why groin post-venipuncture rebleeding often occurs during the transition from supine to sitting under compression bandage application and found that it increased more than threefold when raising the upper body (8.6 ± 4.1 to 27.6 ± 6.9 mmHg; P < 0.001). Based on that data, we created a novel hemostatic belt. Its capability test including 25 participants demonstrated that the belt gave much higher compression pressures on the right groin while sitting than the compression bandage (59.5 ± 14.9 vs. 8.1 ± 4 mmHg; P < 0.001), achieving pressures above the maximum femoral vein pressure in 92% of participants. A randomized trial comparing the belt with compression bandage in 74 AF patients demonstrated that the belt reduced time to ambulation without any rebleeding (340 [92.5-360] vs. 360 [360-360] min; P < 0.001) and satisfied more patients. The novel hemostatic belt provided a much higher compression pressure on the right groin during the sitting position than the conventional compression bandage, achieving a pressure above the maximum femoral vein pressure in 92% of the participants.
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Affiliation(s)
- Akinori Sairaku
- Department of Cardiology, Cardiovascular Center, National Hospital Organization Higashihiroshima Medical Center, 513 Jike, Saijo-cho, Higashihiroshima, 739-0041, Japan.
- Department of Cardiology, Cardiovascular Center, Onomichi General Hospital, Onomichi, Japan.
| | - Koji Hashimoto
- Hiroshima Prefectural Technology Research Institute, Hiroshima, Japan
| | - Yukiko Nakano
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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11
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Kisling AJ, Symons JG, Daubert JP. Catheter ablation of atrial fibrillation: anticipating and avoiding complications. Expert Rev Med Devices 2023; 20:929-941. [PMID: 37691572 DOI: 10.1080/17434440.2023.2257131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 09/06/2023] [Indexed: 09/12/2023]
Abstract
INTRODUCTION Atrial fibrillation (AF) ablation is being performed more frequently and more widely at more centers. This stems from several factors including 1) demographic forces leading to an increased prevalence of the arrhythmia; 2) greater availability of ambulatory monitoring making diagnosis more frequent; 3) relative inefficacy of medications; and 4) improved safety and efficacy of the procedure. Ablation has become much more streamlined and reproducible than a decade ago, but life-threatening complications may still arise. AREAS COVERED This review will focus on awareness, avoidance, and early recognition and management of complications of AF ablation. This literature review is challenged by differing approaches to ablation of AF both within a center and between centers, the rapid improvement of technology making the outcomes associated with a therapeutic strategy begun a few years prior relatively obsolete, as well as the heterogeneity of the population being studied. EXPERT OPINION Newer technologies are on the horizon which will allow us to ablate AF with increasing efficacy, efficiency, and hopefully safety. Such new technology and changing usage mandate vigilance to avoid complications.
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Affiliation(s)
- Adam J Kisling
- Walter Reed National Military Medical Center, Department of Cardiology, Bethesda, MD, United States of America
| | - John G Symons
- Walter Reed National Military Medical Center, Department of Electrophysiology, Bethesda, MD, United States of America
| | - James P Daubert
- Electrophysiology Section/Duke Center for Atrial Fibrillation, Division of Cardiology, Duke Clinical Research Institute, Department of Medicine, Duke University, Durham, NC, United States of America
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12
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Vascular Closure Devices versus Manual Compression in Cardiac Interventional Procedures: Systematic Review and Meta-Analysis. Cardiovasc Ther 2022; 2022:8569188. [PMID: 36134143 PMCID: PMC9482152 DOI: 10.1155/2022/8569188] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 08/20/2022] [Accepted: 08/22/2022] [Indexed: 11/18/2022] Open
Abstract
Backgrounds Manual compression (MC) and vascular closure device (VCD) are two methods of vascular access site hemostasis after cardiac interventional procedures. However, there is still controversial over the use of them and a lack of comprehensive and systematic meta-analysis on this issue. Methods Original articles comparing VCD and MC in cardiac interventional procedures were searched in PubMed, EMbase, Cochrane Library, and Web of Science through April 2022. Efficacy, safety, patient satisfaction, and other parameters were assessed between two groups. Heterogeneity among studies was evaluated by I2 index and the Cochran Q test, respectively. Publication bias was assessed using the funnel plot and Egger's test. Results A total of 32 studies were included after screening with inclusion and exclusion criteria (33481 patients). This meta-analysis found that VCD resulted in shorter time to hemostasis, ambulation, and discharge (p < 0.00001). In terms of vascular complication risks, VCD group might be associated with a lower risk of major complications (p = 0.0001), but the analysis limited to randomized controlled trials did not support this result (p = 0.68). There was no significant difference in total complication rates (p = 0.08) and bleeding-related complication rates (p = 0.05) between the two groups. Patient satisfaction was higher in VCD group (p = 0.002). Meta-regression analysis revealed no specific covariate as an influencing factor for above results (p > 0.05). Conclusions Compared with MC, the use of VCDs significantly shortens the time of hemostasis and allows earlier ambulation and discharge, meanwhile without increase in vascular complications. In addition, use of VCDs achieves higher patient satisfaction and leads cost savings for patients and institutions.
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Flores G, Mesa D, Ojeda S, de Lezo JS, Gonzalez-Manzanares R, Dueñas G, Pan M. Complications of the Percutaneous Mitral Valve Edge-To-Edge Repair: Role of Transesophageal Echocardiography. J Clin Med 2022; 11:jcm11164747. [PMID: 36012985 PMCID: PMC9410310 DOI: 10.3390/jcm11164747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/08/2022] [Accepted: 08/11/2022] [Indexed: 11/17/2022] Open
Abstract
The use of transcatheter edge-to-edge repair for the treatment of mitral regurgitation has markedly increased in the last few years. The rate of adverse events related to the procedure is low; however, some of the complications that may occur are potentially dangerous. Due to the growing popularity of the technique, which is no longer limited to high-volume centers, knowledge of the complications related to the procedure is fundamental. Transesophageal echocardiography has a key role in the guidance of the intervention while allowing for the avoidance of most of these adverse events, as well as enabling us to diagnose them early. In this article, we review the main complications that might present during a transcatheter mitral edge-to-edge repair procedure (tamponade, thromboembolic events, single leaflet device attachment, device embolization, vascular injury…) while highlighting key aspects of transesophageal echocardiographic monitoring in the prevention and prompt diagnosis of these complications.
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Affiliation(s)
- Guisela Flores
- Cardiology Department, Reina Sofia University Hospital, 14004 Cordoba, Spain
- Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), 14004 Cordoba, Spain
| | - Dolores Mesa
- Cardiology Department, Reina Sofia University Hospital, 14004 Cordoba, Spain
- Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), 14004 Cordoba, Spain
- Correspondence:
| | - Soledad Ojeda
- Cardiology Department, Reina Sofia University Hospital, 14004 Cordoba, Spain
- Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), 14004 Cordoba, Spain
- Faculty of Medicine and Nursing, University of Cordoba, 14004 Cordoba, Spain
| | - Javier Suárez de Lezo
- Cardiology Department, Reina Sofia University Hospital, 14004 Cordoba, Spain
- Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), 14004 Cordoba, Spain
| | - Rafael Gonzalez-Manzanares
- Cardiology Department, Reina Sofia University Hospital, 14004 Cordoba, Spain
- Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), 14004 Cordoba, Spain
| | - Guillermo Dueñas
- Cardiology Department, Reina Sofia University Hospital, 14004 Cordoba, Spain
- Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), 14004 Cordoba, Spain
| | - Manuel Pan
- Cardiology Department, Reina Sofia University Hospital, 14004 Cordoba, Spain
- Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), 14004 Cordoba, Spain
- Faculty of Medicine and Nursing, University of Cordoba, 14004 Cordoba, Spain
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14
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Arai H, Shigeta T, Sagawa Y, Oda A, Sudo K, Hara K, Asano M, Shimura T, Suzuki H, Kurabayashi M, Arima H, Itoh S, Goya M, Sasano T, Yamauchi Y. Femoral Vein Occlusion or Stenosis Using a Suture-Mediated Vascular Closure Device After Catheter Ablation. JACC Case Rep 2022; 4:626-631. [PMID: 35615217 PMCID: PMC9125521 DOI: 10.1016/j.jaccas.2022.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 02/22/2022] [Accepted: 03/21/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Hirofumi Arai
- Department of Cardiology, Yokohama City Minato Red Cross Hospital, Yokohama, Kanagawa, Japan
| | - Takatoshi Shigeta
- Department of Cardiology, Yokohama City Minato Red Cross Hospital, Yokohama, Kanagawa, Japan
| | - Yuichiro Sagawa
- Department of Cardiology, Yokohama City Minato Red Cross Hospital, Yokohama, Kanagawa, Japan
| | - Atsuhito Oda
- Department of Cardiology, Yokohama City Minato Red Cross Hospital, Yokohama, Kanagawa, Japan
| | - Koji Sudo
- Department of Cardiology, Yokohama City Minato Red Cross Hospital, Yokohama, Kanagawa, Japan
| | - Karina Hara
- Department of Cardiology, Yokohama City Minato Red Cross Hospital, Yokohama, Kanagawa, Japan
| | - Mitutoshi Asano
- Department of Cardiology, Yokohama City Minato Red Cross Hospital, Yokohama, Kanagawa, Japan
| | - Tsukasa Shimura
- Department of Cardiology, Yokohama City Minato Red Cross Hospital, Yokohama, Kanagawa, Japan
| | - Hidetoshi Suzuki
- Department of Cardiology, Yokohama City Minato Red Cross Hospital, Yokohama, Kanagawa, Japan
| | - Manabu Kurabayashi
- Department of Cardiology, Yokohama City Minato Red Cross Hospital, Yokohama, Kanagawa, Japan
| | - Hideki Arima
- Department of Cardiology, Yokohama City Minato Red Cross Hospital, Yokohama, Kanagawa, Japan
| | - Satoshi Itoh
- Department of Cardiovascular Surgery, Yokohama City Minato Red Cross Hospital, Yokohama, Kanagawa, Japan
| | - Masahiko Goya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yasuteru Yamauchi
- Department of Cardiology, Yokohama City Minato Red Cross Hospital, Yokohama, Kanagawa, Japan
- Address for correspondence: Dr Yasuteru Yamauchi, Department of Cardiology, Yokohama City Minato Red Cross Hospital, 3-12-1 Shinyamashita, Naka, Yokohama, Kanagawa 231-8682, Japan.
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15
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Innovations in atrial fibrillation ablation. J Interv Card Electrophysiol 2022; 66:737-756. [PMID: 35411440 DOI: 10.1007/s10840-022-01215-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 04/05/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Catheter-based ablation to perform pulmonary vein isolation (PVI) has established itself as a mainstay in the rhythm control strategy of atrial fibrillation. This review article aims to provide an overview of recent advances in atrial fibrillation ablation technology. METHODS We reviewed the available literature and clinical trials of innovations in atrial fibrillation ablation technologies including ablation catheter designs, alternative energy sources, esophageal protection methods, electroanatomical mapping, and novel ablation targets. RESULTS Innovative radiofrequency (RF) catheter designs maximize energy delivery while avoiding overheating associated with conventional catheters. Single-shot balloon catheters in the form of cryoballoons, radiofrequency, and laser balloons have proven effective at producing pulmonary vein isolation and improving procedural efficiency and reproducibility. Pulsed field ablation (PFA) is a highly anticipated novel nonthermal energy source under development, which demonstrates selective ablation of the myocardium, producing durable lesions while also minimizing collateral damage. Innovative devices for esophageal protection including esophageal deviation and cooling devices have been developed to reduce esophageal complications. Improved electroanatomical mapping systems are being developed to help identify additional non-pulmonary triggers, which may benefit from ablation, especially with persistent atrial fibrillation. Lastly, the vein of Marshall alcohol ablation has been recently studied as an adjunct therapy for improving outcomes with catheter ablation for persistent atrial fibrillation. CONCLUSIONS Numerous advances have been made in the field of atrial fibrillation ablation in the past decade. While further long-term data is still needed for these novel technologies, they show potential to improve procedural efficacy and safety.
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Field ME, Goldstein L, Corriveau K, Khanna R, Fan X, Gold MR. Evaluating outcomes of same-day discharge after catheter ablation for atrial fibrillation in a real-world cohort. Heart Rhythm O2 2021; 2:333-340. [PMID: 34430938 PMCID: PMC8369301 DOI: 10.1016/j.hroo.2021.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background As same-day discharge (SDD) after catheter ablation (CA) for atrial fibrillation (AF) is increasingly utilized, it is important to further investigate this approach. Objective To investigate the safety and efficacy of SDD after CA for AF in a large nationwide administrative sample. Methods The IBM MarketScan Commercial Claims and Encounters database was used to identify adult patients under 65 years undergoing CA for AF (2016-2020). Eligible patients were indexed to date of first CA and classified into SDD or overnight stay (ONS) groups based on length of service. A 1:3 propensity score matching was used to create comparable SDD:ONS samples. Study outcomes were CA-related complications within 30 days after index procedure and AF recurrence within 1 year. Cox proportional hazards models were estimated for outcome comparison. Results In the postmatch 30-day cohort, there were 1610 SDD and 4637 ONS patients with mean age 56.1 (± 7.6) years. There was no significant difference in composite 30-day postprocedural complication rate between SDD and ONS groups (2.7% vs 2.8%, respectively; P = .884). The most common complications were cerebrovascular events (0.7% vs 0.7%; P = .948), vascular access events (0.6% vs 0.6%; P = .935), and pericardial complications (0.6% vs 0.5%; P = .921). Further, no significant difference in composite AF recurrence rate at 1 year was observed among SDD and ONS groups (10.2% vs 8.8%; hazard ratio = 1.167; 95% confidence interval 0.935-1.455; P = .172). Conclusion In a large, propensity-matched, real-world sample, SDD appears to be safe and have similar outcomes compared with overnight observation following CA for AF.
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Affiliation(s)
- Michael E. Field
- Medical University of South Carolina, Charleston, South Carolina
- Address reprint requests and correspondence: Dr Michael E. Field, Department of Medicine, Medical University of South Carolina, 30 Courtenay Dr, MSC592, Charleston, SC 29425.
| | - Laura Goldstein
- Medical Devices Franchise Health Economics and Market Access, Johnson & Johnson, Irvine, California
| | - Kevin Corriveau
- Medical Devices Franchise Health Economics and Market Access, Johnson & Johnson, Irvine, California
| | - Rahul Khanna
- Medical Device Epidemiology and Real-World Data Sciences, Johnson and Johnson, New Brunswick, New Jersey
| | - Xiaozhou Fan
- Medical Device Epidemiology and Real-World Data Sciences, Johnson and Johnson, New Brunswick, New Jersey
| | - Michael R. Gold
- Medical University of South Carolina, Charleston, South Carolina
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