Bilateral Cardiac Catheterizations The Safety and Feasibility of a Superficial Forearm Venous and Transradial Arterial Approach

Invasive Haemodynamic Assessment Before and After Left Ventricular Assist Device Implantation: A Guide to Current Practice

Mechanical circulatory support for the management of advanced heart failure is a rapidly evolving field. The number of durable long-term left ventricular assist device (LVAD) implantations increases each year, either as a bridge to heart transplantation or as a stand-alone ‘destination therapy’ to improve quantity and quality of life for people with end-stage heart failure. Advances in cardiac imaging and non-invasive assessment of cardiac function have resulted in a diminished role for right heart catheterisation (RHC) in general cardiology practice; however, it remains an essential tool in the evaluation of potential LVAD recipients, and in their long-term management. In this review, the authors discuss practical aspects of performing RHC and potential complications. They describe the haemodynamic markers associated with a poor prognosis in patients with left ventricular systolic dysfunction and evaluate the measures of right ventricular (RV) function that predict risk of RV failure following LVAD implantation. They also discuss the value of RHC in the perioperative period; when monitoring for longer term complications; and in the assessment of potential left ventricular recovery.

Right Cardiac Catheterization Using the Antecubital Fossa Vein in Korean Patients

Background and Objectives

Right heart catheterization is traditionally performed using a femoral vein approach that involves admission, bed rest, and risks of bleeding and hematoma. Recent studies have confirmed safety of the use of forearm vein for right cardiac catheterization. In the present study, we evaluated the feasibility of right cardiac catheterization via the antecubital fossa vein in Korean patients.

Subjects and Methods

The medical records of all patients who underwent right heart catheterization at our hospital between January 2003 and December 2014 were reviewed retrospectively. Right cardiac catheterizations via the antecubital fossa vein and the femoral vein were compared in terms of demographic data (age, sex, weight, height, and body mass index), indications for right cardiac catheterization, and procedural and outcome data (initial success rate, procedure time, compression to ambulation time, and complications).

Results

We reviewed 132 cases (antecubital fossa vein approach, n=37; femoral vein approach, n=95). The demographic data, initial success rate (100% vs. 100%) and procedure time (21.6±16.8 min vs. 25.6±12.6 min, p=0.14) were similar in both groups. The antecubital fossa vein group had a shorter mean compression to ambulation time than the femoral vein group (0.0 min vs. 201.2±48.1 min, p<0.01). No complications were observed in either group.

Conclusion

Our study indicated the ease of performance of right cardiac catheterization via the antecubital fossa vein. Thus, the antecubital fossa vein can be an alternative access site for right cardiac catheterization in Korean patients.

Comparison of Brachial Vein Versus Internal Jugular Vein Approach for Access to the Right Side of the Heart With or Without Myocardial Biopsy

Right heart catheterization (RHC) and endomyocardial biopsy are mainstay procedures for patients with heart failure and heart transplantation. Approaches are predominantly neck (internal jugular) or leg (femoral vein). We describe a novel arm (brachial/basilica vein) approach. Over 5.5 years, 1,130 right-sided cardiac procedures in 276 patients were analyzed retrospectively and divided into either neck or arm approach. Comparative analyses of procedural success, time, safety, efficacy, and cost were performed. Patient preference was assessed for those who had both neck and arm approaches. In patients receiving RHC (174 neck and 121 arm cases) and in those receiving RHC + biopsy (594 neck and 141 arm cases), mean elapsed and fluoroscopic times (minutes), respectively, were 60 ± 20 versus 62 ± 19 and 3.43 ± 3.8 versus 4.99 ± 5.2 (RHC neck vs arm, respectively), and 55 ± 19 versus 63 ± 17 and 4.14 ± 3.4 versus 5.22 ± 2.6 (RHC + biopsy neck vs arm, respectively). Procedural complications were low (n = 7, 0.6%) and restricted to the neck approach. Patients surveyed preferred the arm approach. In conclusion, RHC and endomyocardial biopsy through the brachial vein can be performed safely, timely, effectively, and at equivalent cost compared with a neck approach. We advocate that an arm approach be the preferred method for these procedures.

Transbrachial access for radiologic manipulation of problematic central venous catheters in a pediatric population

A transfemoral venous approach is the current standard for accessing malpositioned and fractured central venous catheters (CVCs). The purpose of this study was (1) to describe a transbrachial approach for correction and (2) to assess the success and failure of this method in a pediatric population. A 12-year retrospective review of all patients referred for correction of malpositioned, retained, and fractured CVCs was conducted. Based on the performing interventionalist's preference, transbrachial or transfemoral venous sheaths where placed under ultrasonographic guidance. Diagnostic angiographic catheters and snares were used to manipulate the catheters. Patients who underwent the transfemoral approach received postprocedural monitoring for 4 hours, whereas patients who underwent the transbrachial approach were allowed unrestricted activity immediately after hemostasis was obtained. Technical success of malpositioned lines was defined (1) by final position in the superior vena cava or at the cavoatrial junction on postprocedural imaging or (2) by successful removal of retained catheter fragments, if present. Transbrachial approach was used for access in 11 patients. Problematic lines included malpositioned (n = 10) and retained (n = 1) lines. The ipsilateral arm was used for transbrachial entry in 7 patients. Initial use of angiographic catheters was attempted in 7 cases, of which 4 were successful. All 3 unsuccessful cases had tips positioned in the contralateral brachiocephalic vein, and these were successfully repositioned using snares. A combination of snares and angiographic catheters was used in 2 cases. Snares were used for all other cases. Technical success by way of the transbrachial approach was observed in all cases. Periprocedural follow-up demonstrated no immediate complications. We conclude that the transbrachial approach is a suitable alternative to the transfemoral approach for catheter tip position correction. Tip malposition in the contralateral brachiocephalic vein suggests higher rate of conversion to use of snare devices.

Safety and efficacy of transradial vs transfemoral arterial primary coronary angioplasty for acute myocardial infarction: single-center experience

BACKGROUND

The aim of the present study was to test the hypothesis that the transradial arterial approach (TRA) is not inferior to the transfemoral arterial approach (TFA) for <or=Killip 3 acute myocardial infarction (AMI) patients undergoing primary percutaneous coronary intervention (PCI).

METHODS AND RESULTS

This study enrolled 506 AMI patients undergoing primary PCI using the TRA (group 1) between March 2002 and May 2007, and 810 AMI patients undergoing primary PCI using TFA (group 2) between May 1993 and February 2002. The results demonstrated that puncture to first balloon-inflation time was similar in both groups; however, the procedure time was shorter in group 1 than in group 2 (P<0.0001). Additionally, the incidences of stenting, tirofiban therapy and final normal coronary blood flow of the infarct-related artery were higher, whereas the frequency of intra-aortic balloon pump support was lower in group 1 than in group 2 (all P<0.02). Although the 30-day mortality rate did not differ between the 2 groups (P=0.341), the rate of combined major vascular and bleeding complications was higher in group 2 than in group 1 (P<0.0001).

CONCLUSIONS

Initial selection of TRA is not inferior to initial selection of TFA for AMI patients undergoing primary PCI. However, in the present study, the incidence of combined vascular and bleeding complications was lower with the TRA than with the TFA approach.