Suture-based techniques versus manual compression for femoral venous haemostasis after electrophysiology procedures

IF 2.6 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Journal of Cardiovascular Electrophysiology Pub Date : 2024-09-04 DOI:10.1111/jce.16417

Mark T. Mills MBChB, MSc, Peter Calvert MBChB, Richard Snowdon MD, Saagar Mahida PhD, Johan Waktare MD, Zoltan Borbas PhD, Reza Ashrafi MBBS, Derick Todd MD, Simon Modi MD, Vishal Luther PhD, Dhiraj Gupta MD

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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 (Fo8_HT) or a modified figure-of-eight suture secured with a 3-way stopcock (Fo8_MOD). We hypothesised that short-term bleeding outcomes using the Fo8_MOD approach would be superior to MC. We additionally compared outcomes between Fo8_MOD and Fo8_HT 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, Fo8_HT and Fo8_MOD. 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%); Fo8_HT 105 (9.6%); Fo8_MOD 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%), Fo8_MOD associated with fewer complications than MC or Fo8_HT (major: MC 2.2%, Fo8_HT 6.0%, Fo8_MOD 0.8%, p = .01; minor: MC 16.5%, Fo8_HT 12.0%, Fo8_MOD 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, Fo8_MOD 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 Fo8_MOD associates with fewer access site complications than MC and Fo8_HT following EP procedures that need periprocedural anticoagulation.

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电生理学手术后股静脉止血的缝合技术与人工压迫技术对比。

背景和目的：电生理学（EP）手术后股静脉止血的方法包括人工压迫（MC）和缝合技术，如用手打结固定的八字形缝合线（Fo8HT）或用三向止血塞固定的改良八字形缝合线（Fo8MOD）。我们假设使用 Fo8MOD 方法的短期出血效果将优于 MC。我们还比较了 Fo8MOD 和 Fo8HT 两种方法的效果：我们对 2023 年 3 月至 12 月期间在我院接受 EP 手术的连续患者进行了研究。患者被分为三个止血组：MC、Fo8HT 和 Fo8MOD。入路部位并发症分为重大并发症（需要干预或输血、延迟出院或导致死亡）和轻微并发症（出血/血肿，需要额外压迫）：结果：共纳入 1089 名患者：结果：共纳入 1089 例患者：MC 718 例（65.9%）；Fo8HT 105 例（9.6%）；Fo8MOD 266 例（24.4%）。最常见的手术是针对心房颤动（52.4%）、心房扑动（10.9%）和房室结再发性心动过速（10.1%）。在接受围手术期抗凝治疗的患者中（865 人，79.4%），Fo8MOD 的并发症少于 MC 或 Fo8HT（主要并发症：MC 2.2%，Fo8HT 2.2%）：主要并发症：MC 2.2%，Fo8HT 6.0%，Fo8MOD 0.8%，P = 0.01；次要并发症：MC 16.5%，Fo8HT 6.0%，Fo8MOD 0.8%：MC为16.5%，Fo8HT为12.0%，Fo8MOD为7.4%，P = .002）。在未接受围术期抗凝治疗的患者中，不同止血方法的并发症并无差异（主要和次要并发症总计 5.8%，组间比率 p = .729）。在多变量逻辑回归中，Fo8MOD 与入路部位并发症风险显著降低相关（OR 0.29 [95% CI 0.17-0.48]，P 结论：Fo8MOD 与入路部位并发症风险显著降低相关：与 MC 和 Fo8HT 相比，在需要进行围手术期抗凝的 EP 手术后，使用 Fo8MOD 进行股骨止血可减少入路部位并发症。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Cardiovascular Electrophysiology 医学-心血管系统

CiteScore

5.20

自引率

14.80%

发文量

433

审稿时长

3-6 weeks

期刊介绍： Journal of Cardiovascular Electrophysiology (JCE) keeps its readership well informed of the latest developments in the study and management of arrhythmic disorders. Edited by Bradley P. Knight, M.D., and a distinguished international editorial board, JCE is the leading journal devoted to the study of the electrophysiology of the heart.