Mark T Mills, Peter Calvert, Richard Snowdon, Saagar Mahida, Johan Waktare, Zoltan Borbas, Reza Ashrafi, Derick Todd, Simon Modi, Vishal Luther, Dhiraj Gupta
{"title":"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。","authors":"Mark T Mills, Peter Calvert, Richard Snowdon, Saagar Mahida, Johan Waktare, Zoltan Borbas, Reza Ashrafi, Derick Todd, Simon Modi, Vishal Luther, Dhiraj Gupta","doi":"10.1111/jce.16417","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and aims: </strong>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<sub>HT</sub>) or a modified figure-of-eight suture secured with a 3-way stopcock (Fo8<sub>MOD</sub>). We hypothesised that short-term bleeding outcomes using the Fo8<sub>MOD</sub> approach would be superior to MC. We additionally compared outcomes between Fo8<sub>MOD</sub> and Fo8<sub>HT</sub> approaches.</p><p><strong>Methods: </strong>We studied consecutive patients undergoing EP procedures at our institution between March and December 2023. Patients were categorised into three haemostasis groups: MC, Fo8<sub>HT</sub> and Fo8<sub>MOD</sub>. 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).</p><p><strong>Results: </strong>1089 patients were included: MC 718 (65.9%); Fo8<sub>HT</sub> 105 (9.6%); Fo8<sub>MOD</sub> 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<sub>MOD</sub> associated with fewer complications than MC or Fo8<sub>HT</sub> (major: MC 2.2%, Fo8<sub>HT</sub> 6.0%, Fo8<sub>MOD</sub> 0.8%, p = .01; minor: MC 16.5%, Fo8<sub>HT</sub> 12.0%, Fo8<sub>MOD</sub> 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<sub>MOD</sub> 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.</p><p><strong>Conclusion: </strong>Femoral haemostasis with Fo8<sub>MOD</sub> associates with fewer access site complications than MC and Fo8<sub>HT</sub> following EP procedures that need periprocedural anticoagulation.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":null,"pages":null},"PeriodicalIF":2.3000,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Suture-based techniques versus manual compression for femoral venous haemostasis after electrophysiology procedures.\",\"authors\":\"Mark T Mills, Peter Calvert, Richard Snowdon, Saagar Mahida, Johan Waktare, Zoltan Borbas, Reza Ashrafi, Derick Todd, Simon Modi, Vishal Luther, Dhiraj Gupta\",\"doi\":\"10.1111/jce.16417\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background and aims: </strong>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<sub>HT</sub>) or a modified figure-of-eight suture secured with a 3-way stopcock (Fo8<sub>MOD</sub>). We hypothesised that short-term bleeding outcomes using the Fo8<sub>MOD</sub> approach would be superior to MC. We additionally compared outcomes between Fo8<sub>MOD</sub> and Fo8<sub>HT</sub> approaches.</p><p><strong>Methods: </strong>We studied consecutive patients undergoing EP procedures at our institution between March and December 2023. Patients were categorised into three haemostasis groups: MC, Fo8<sub>HT</sub> and Fo8<sub>MOD</sub>. 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).</p><p><strong>Results: </strong>1089 patients were included: MC 718 (65.9%); Fo8<sub>HT</sub> 105 (9.6%); Fo8<sub>MOD</sub> 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<sub>MOD</sub> associated with fewer complications than MC or Fo8<sub>HT</sub> (major: MC 2.2%, Fo8<sub>HT</sub> 6.0%, Fo8<sub>MOD</sub> 0.8%, p = .01; minor: MC 16.5%, Fo8<sub>HT</sub> 12.0%, Fo8<sub>MOD</sub> 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<sub>MOD</sub> 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.</p><p><strong>Conclusion: </strong>Femoral haemostasis with Fo8<sub>MOD</sub> associates with fewer access site complications than MC and Fo8<sub>HT</sub> following EP procedures that need periprocedural anticoagulation.</p>\",\"PeriodicalId\":15178,\"journal\":{\"name\":\"Journal of Cardiovascular Electrophysiology\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.3000,\"publicationDate\":\"2024-09-04\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Cardiovascular Electrophysiology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1111/jce.16417\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Cardiovascular Electrophysiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1111/jce.16417","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Suture-based techniques versus manual compression for femoral venous haemostasis after electrophysiology procedures.
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.
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.