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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; 35:1952-1959. [PMID: 39099135 DOI: 10.1111/jce.16381] [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: 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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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; 21:2028-2036. [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] [MESH Headings] [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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Mills MT, Calvert P, Snowdon R, Mahida S, Waktare J, Borbas Z, Ashrafi R, Todd D, Modi S, Luther V, Gupta D. Suture-based techniques versus manual compression for femoral venous haemostasis after electrophysiology procedures. J Cardiovasc Electrophysiol 2024. [PMID: 39233396 DOI: 10.1111/jce.16417] [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: 07/18/2024] [Revised: 08/05/2024] [Accepted: 08/12/2024] [Indexed: 09/06/2024]
Abstract
BACKGROUND AND AIMS Methods for femoral venous haemostasis following electrophysiology (EP) procedures include manual compression (MC) and suture-based techniques such as a figure-of-eight suture secured with a hand-tied knot (Fo8HT) or a modified figure-of-eight suture secured with a 3-way stopcock (Fo8MOD). We hypothesised that short-term bleeding outcomes using the Fo8MOD approach would be superior to MC. We additionally compared outcomes between Fo8MOD and Fo8HT approaches. METHODS We studied consecutive patients undergoing EP procedures at our institution between March and December 2023. Patients were categorised into three haemostasis groups: MC, Fo8HT and Fo8MOD. Access site complications were classified as major (requiring intervention or blood transfusion, delaying discharge or resulting in death) or minor (bleeding/haematoma requiring additional compression). RESULTS 1089 patients were included: MC 718 (65.9%); Fo8HT 105 (9.6%); Fo8MOD 266 (24.4%). Procedures were most commonly for atrial fibrillation (52.4%), atrial flutter (10.9%), and atrioventricular nodal re-entrant tachycardia (10.1%). In patients receiving periprocedural anticoagulation (865, 79.4%), Fo8MOD associated with fewer complications than MC or Fo8HT (major: MC 2.2%, Fo8HT 6.0%, Fo8MOD 0.8%, p = .01; minor: MC 16.5%, Fo8HT 12.0%, Fo8MOD 7.4%, p = .002). In patients not receiving periprocedural anticoagulation, complications did not differ between haemostasis methods (total major and minor complications 5.8%, p = .729 for between groups rates). On multivariable logistic regression, Fo8MOD was associated with a significantly lower risk of access site complications (OR 0.29 [95% CI 0.17-0.48], p < .001), whilst intraprocedural heparinisation (OR 5.25 [2.88-9.69], p < .001) and larger maximal sheath size (OR 1.06 [1.00-1.11], p = .04) were associated with a higher risk of complications. CONCLUSION Femoral haemostasis with Fo8MOD associates with fewer access site complications than MC and Fo8HT following EP procedures that need periprocedural anticoagulation.
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Affiliation(s)
- Mark T Mills
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Liverpool Heart & Chest Hospital NHS Foundation Trust, Thomas Drive, Liverpool, L14 3PE, UK
| | - Peter Calvert
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Liverpool Heart & Chest Hospital NHS Foundation Trust, Thomas Drive, Liverpool, L14 3PE, UK
| | - Richard Snowdon
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Saagar Mahida
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Johan Waktare
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Zoltan Borbas
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Reza Ashrafi
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Derick Todd
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Simon Modi
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Vishal Luther
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Liverpool Heart & Chest Hospital NHS Foundation Trust, Thomas Drive, Liverpool, L14 3PE, UK
| | - Dhiraj Gupta
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Liverpool Heart & Chest Hospital NHS Foundation Trust, Thomas Drive, Liverpool, L14 3PE, UK
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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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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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Yorgun H, Şener YZ, Tanese N, Keresteci A, Sezenöz B, Çöteli C, Ateş AH, Boveda S, Aytemir K. Long-term outcomes of left atrial appendage isolation using cryoballoon in persistent atrial fibrillation. Europace 2023; 25:366-373. [PMID: 36164853 PMCID: PMC10103563 DOI: 10.1093/europace/euac167] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 08/31/2022] [Indexed: 11/13/2022] Open
Abstract
AIMS There is an increasing trend evaluating the role of non-pulmonary vein (PV) triggers to improve ablation outcomes in persistent atrial fibrillation (AF) as pulmonary vein isolation (PVI) strategy alone has modest outcomes. We investigated the long-term safety and efficacy of left atrial appendage isolation (LAAi) in addition to PVI using cryoballoon (CB) in persistent AF. METHODS AND RESULTS In this multicentre retrospective analysis, we included a total of 193 persistent AF patients (mean age: 60 ± 11 years, 50.3% females) who underwent PVI and LAAi using CB. Baseline and follow-up data including electrocardiography (ECG), 24 h Holter ECGs, and echocardiography were recorded for all patients. Atrial tachyarrhythmia (ATa) recurrence was defined as the detection of AF, atrial flutter, or atrial tachycardia (≥30 s) after a 3-month blanking period. At a median follow-up of 55 (36.5-60.0) months, 85 (67.9%) patients with PVI + LAAi were in sinus rhythm after the index procedure. Ischaemic stroke/transient ischemic attack occurred in 14 (7.2%) patients at a median of 24 (2-53) months following catheter ablation. Multivariate regression analysis revealed heart failure with preserved ejection fraction [hazard ratio (HR) 2.29, 95% confidence interval (CI) 1.04-5.02; P = 0.038], male gender (HR 0.53, 95% CI 0.29-0.96; P = 0.037), and LA area (HR 1.04, 95% CI 0.53-1.32; P = 0.023) as independent predictors of ATa recurrence. CONCLUSION Our findings demonstrated that the LAAi + PVI strategy using CB had acceptable long-term outcomes in patients with persistent AF. Systemic thrombo-embolic events are an important concern throughout the follow-up, which were mostly observed in case of non-adherence to anticoagulants.
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Affiliation(s)
- Hikmet Yorgun
- Faculty of Medicine, Department of Cardiology, Hacettepe University, Ankara 06230, Turkey.,Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Yusuf Ziya Şener
- Faculty of Medicine, Department of Cardiology, Hacettepe University, Ankara 06230, Turkey
| | - Nikita Tanese
- Department of Cardiology, Clinique Pasteur, Toulouse, France
| | - Ahmet Keresteci
- Faculty of Medicine, Department of Cardiology, Hacettepe University, Ankara 06230, Turkey
| | - Burak Sezenöz
- Faculty of Medicine, Department of Cardiology, Gazi University, Ankara, Turkey
| | - Cem Çöteli
- Faculty of Medicine, Department of Cardiology, Hacettepe University, Ankara 06230, Turkey
| | - Ahmet Hakan Ateş
- Faculty of Medicine, Department of Cardiology, Hacettepe University, Ankara 06230, Turkey
| | - Serge Boveda
- Department of Cardiology, Clinique Pasteur, Toulouse, France
| | - Kudret Aytemir
- Faculty of Medicine, Department of Cardiology, Hacettepe University, Ankara 06230, Turkey
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7
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Sanghai S, Sandhu U, Verdick C, Krebsbach A, Glover A, Beitinjaneh B, Golwala H, Henrikson CA. Figure-of-Eight Sutures in Fully Anticoagulated Patients After Left Atrial Appendage Occlusion May Obviate Need for Anticoagulation Reversal: Vascular Management After LAAO. Circ Arrhythm Electrophysiol 2021; 14:e010268. [PMID: 34565167 DOI: 10.1161/circep.121.010268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Saket Sanghai
- Division of Cardiovascular Medicine, Department of Medicine, Knight Cardiovascular Institute, Oregon Health & Science University, Portland OR
| | - Uday Sandhu
- Division of Cardiovascular Medicine, Department of Medicine, Knight Cardiovascular Institute, Oregon Health & Science University, Portland OR
| | - Christopher Verdick
- Division of Cardiovascular Medicine, Department of Medicine, Knight Cardiovascular Institute, Oregon Health & Science University, Portland OR
| | - Angela Krebsbach
- Division of Cardiovascular Medicine, Department of Medicine, Knight Cardiovascular Institute, Oregon Health & Science University, Portland OR
| | - Anne Glover
- Division of Cardiovascular Medicine, Department of Medicine, Knight Cardiovascular Institute, Oregon Health & Science University, Portland OR
| | - Bassel Beitinjaneh
- Division of Cardiovascular Medicine, Department of Medicine, Knight Cardiovascular Institute, Oregon Health & Science University, Portland OR
| | - Harsh Golwala
- Division of Cardiovascular Medicine, Department of Medicine, Knight Cardiovascular Institute, Oregon Health & Science University, Portland OR
| | - Charles A Henrikson
- Division of Cardiovascular Medicine, Department of Medicine, Knight Cardiovascular Institute, Oregon Health & Science University, Portland OR
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8
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Mohammed M, Ramirez R, Steinhaus DA, Yousuf OK, Giocondo MJ, Ramza BM, Wimmer AP, Gupta SK. Comparative outcomes of vascular access closure methods following atrial fibrillation/flutter catheter ablation: insights from VAscular Closure for Cardiac Ablation Registry. J Interv Card Electrophysiol 2021; 64:301-310. [PMID: 33796968 DOI: 10.1007/s10840-021-00981-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 03/15/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE This registry compared the safety and efficacy of vascular closure device Perclose (PC) with figure-of-eight stitch (Fo8) and manual compression (MC) following catheter ablation of atrial fibrillation/flutter. METHODS VAscular Closure for Cardiac Ablation Registry (VACCAR) is a prospective, observational registry that assessed the time to hemostasis (TTH), time to ambulation (TTA), length of stay (LOS), complications, patient-reported outcomes, and pain medication use. RESULTS A total of 434 patients (mean age 64.0±11.0 years; 38% female; 94.9% white) were enrolled between October 2017 and May 2019: 156 in MC, 203 in Fo8, and 75 in the PC group. Median TTH was significantly reduced in the PC and Fo8 group at 7 and 9 min respectively vs. the MC group at 20 min (p<0.001). Median TTA was significantly reduced in both the PC and Fo8 group at 2.2 h vs. the MC group at 6.5 h (p<0.001 for both). Median LOS for the PC group was significantly reduced at 27.5 h compared to the MC and Fo8 group at 29 h (p<0.01). A higher proportion of same-day discharges were noted in the PC and Fo8 groups at 14 (18.7%) and 25 (12.3%), respectively, compared to 5 (3.2%) in the MC group (p<0.01 for all). There was no significant difference in complications between the three groups. CONCLUSIONS Both PC and Fo8 are safe with improved TTH, TTA, LOS, and a higher number of same-day discharges compared to MC.
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Affiliation(s)
- Moghniuddin Mohammed
- Department of Medicine, Saint Luke's Health System, Kansas City, MO, USA
- Department of Biomedical and Health Informatics, University of Missouri, Kansas City, MO, USA
| | - Rigoberto Ramirez
- Division of Cardiology, The University of Kansas Hospital, Kansas City, KS, USA
| | - Daniel A Steinhaus
- Division of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, MO, USA
- University of Missouri Kansas City School of Medicine, 4401 Wornall Road, Kansas City, MO, 64111, USA
| | - Omair K Yousuf
- Division of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, MO, USA
- University of Missouri Kansas City School of Medicine, 4401 Wornall Road, Kansas City, MO, 64111, USA
| | - Michael J Giocondo
- Division of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, MO, USA
- University of Missouri Kansas City School of Medicine, 4401 Wornall Road, Kansas City, MO, 64111, USA
| | - Brian M Ramza
- Division of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, MO, USA
- University of Missouri Kansas City School of Medicine, 4401 Wornall Road, Kansas City, MO, 64111, USA
| | - Alan P Wimmer
- Division of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, MO, USA
- University of Missouri Kansas City School of Medicine, 4401 Wornall Road, Kansas City, MO, 64111, USA
| | - Sanjaya K Gupta
- Division of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, MO, USA.
- University of Missouri Kansas City School of Medicine, 4401 Wornall Road, Kansas City, MO, 64111, USA.
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9
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Mujer MT, Al-Abcha A, Flores J, Saleh Y, Robinson P. A comparison of figure-of-8-suture versus manual compression for venous access closure after cardiac procedures: An updated meta-analysis. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:856-865. [PMID: 32638389 DOI: 10.1111/pace.14008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/09/2020] [Accepted: 07/05/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND Manual compression (MC) is the current standard to achieve postprocedural hemostasis in patients who need venous vascular access closure after cardiovascular procedures. Figure-of-8 (F8) suture for venous access closure has been reported to be a safe and efficacious alternative to MC. METHODS A systematic search was done using PubMed, Google Scholar, EMBASE, SCOPUS, and ClinicalTrials.gov without language restriction up until April 15, 2020 for studies comparing F8 suture versus MC. Risk ratio (RR) and mean difference (MD) with 95% confidence interval (CI) were calculated using a random effects model. RESULTS Time to achieve hemostasis was significantly reduced in the F8 arm [MD -21.04 min (95% CI: -35.66 to -6.42; P = .005)]. Access site bleeding was significantly lower in the F8 group [RR 0.35 (95% CI: 0.18 to 0.66; P = .001)] along with a lower incidence of hematoma formation [RR 0.42 (95% CI: 0.26 to 0.67; P = .0003)]. There was no significant difference in rates of fistula or pseudoaneurysm formation between the two groups. Overall access site complications were lower in the F8 arm [RR 0.38 (95% CI: 0.26 to 0.55; P < .00001)] and the effect was more pronounced for sheaths ≥10 Fr [RR 0.33 (95% CI: 0.18 to 0.60; P = .0003)]. There was lower postprocedural protamine use in the F8 group [RR 0.07 (95% CI: 0.01 to 0.36; P = .001)]. CONCLUSION For large-bore venous access closure, the F8 suture results in a shortened time to achieve hemostasis along with a lower overall risk of access site complications and postprocedural protamine use.
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Affiliation(s)
- Mark Terence Mujer
- Department of Medicine, Michigan State University, East Lansing, Michigan
| | - Abdullah Al-Abcha
- Department of Medicine, Michigan State University, East Lansing, Michigan
| | - Jairus Flores
- University of the Philippines College of Medicine, Manila, Philippines
| | - Yehia Saleh
- Department of Medicine, Michigan State University, East Lansing, Michigan
| | - Peter Robinson
- Pat and Jim Calhoun Cardiology Center, University of Connecticut, Farmington, Connecticut
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Aksu T, Yalin K, Guler TE, Bozyel S, Heeger CH, Tilz RR. Acute Procedural Complications of Cryoballoon Ablation: A Comprehensive Review. J Atr Fibrillation 2019; 12:2208. [PMID: 32435335 DOI: 10.4022/jafib.2208] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 08/14/2019] [Accepted: 08/26/2019] [Indexed: 12/15/2022]
Abstract
Catheter ablation is increasingly performed for treatment of atrial fibrillation (AF). Balloon based procedures have been developed aiming at safer, easier and more effective treatment as compared to point to point ablation. In the present review article, we aimed to discuss acute procedural complications of cryoballoon ablation.
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Affiliation(s)
- Tolga Aksu
- Department of Cardiology, University of Health Sciences, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - Kivanc Yalin
- Istanbul University- Cerrahpasa, Faculty of Medicine, Department of Cardiology, Istanbul, Turkey.,University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Tumer Erdem Guler
- Department of Cardiology, University of Health Sciences, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - Serdar Bozyel
- Department of Cardiology, University of Health Sciences, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - Christian-H Heeger
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Roland R Tilz
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany
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11
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Yasar SJ, Bickel T, Zhang S, Akkaya M, Aznaurov SG, Krishnan K, Cuculich PS, Gautam S. Heparin reversal with protamine sulfate is not required in atrial fibrillation ablation with suture hemostasis. J Cardiovasc Electrophysiol 2019; 30:2811-2817. [PMID: 31661173 DOI: 10.1111/jce.14253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 10/23/2019] [Accepted: 10/25/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND The utility of protamine sulfate for heparin reversal in catheter-based atrial fibrillation (AF) ablation is unclear when using the suture closure technique for vascular hemostasis. OBJECTIVE This study sought to address if protamine sulfate use for heparin reversal reduces vascular access complications in AF catheter ablation when suture techniques are used for postprocedural vascular hemostasis. METHODS This is a retrospective multicenter observational study of 294 consecutive patients who underwent catheter ablation for AF with subsequent vascular access hemostasis by means of a figure-of-eight suture or stopcock technique. A total of 156 patients received protamine for heparin reversal before sheath removal while 138 patients did not receive protamine. The two groups were compared for procedural activated clotting time (ACT), access site complications, and duration of hospital stay. RESULTS Baseline demographic characteristics were comparable in both groups. Despite higher ACT before venous sheath removal in patients not receiving protamine (288.0 ± 44.3 vs 153.9 ± 32.0 seconds; P < .001), there was no significant difference in groin complications, postoperative thromboembolic events, or duration of hospital stay between the two groups. Suture failure requiring manual compression was rarely observed in this cohort (0.34%). CONCLUSION With modern vascular access and sheath management techniques, for patients undergoing catheter ablation for AF, simple suture closure techniques can obviate the need for protamine administration to safely achieve hemostasis after removal of vascular sheaths.
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Affiliation(s)
- Senan J Yasar
- Division of Cardiovascular Medicine, University of Missouri Columbia, Columbia, Missouri
| | - Trent Bickel
- Department of Internal Medicine, University of Missouri Columbia, Columbia, Missouri
| | - Shiyang Zhang
- Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri
| | - Mehmet Akkaya
- Division of Electrophysiology, Rush University Medical Center, Chicago, Illinois
| | - Sam G Aznaurov
- Division of Electrophysiology, Boulder Heart, Boulder, Colorado
| | - Kousik Krishnan
- Division of Electrophysiology, Rush University Medical Center, Chicago, Illinois
| | - Phillip S Cuculich
- Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri
| | - Sandeep Gautam
- Division of Cardiovascular Medicine, University of Missouri Columbia, Columbia, Missouri
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