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Feasibility and Safety of the Antecubital Venous Access for Right Heart Catheterization in Patients With Pulmonary Hypertension
Session:
Painel 11 - Cardiologia Intervenção 4
Speaker:
João Grade Santos
Congress:
CPC 2020
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.3 Non-coronary Cardiac Intervention
Session Type:
Posters
FP Number:
---
Authors:
João Grade Santos; Ana Rita F. Pereira; Filipa Ferreira; Maria José Loureiro; Sofia Alegria; Rita Calé; Débora Repolho; Sílvia Vitorino; Helder Pereira
Abstract
<p><strong>Introduction:</strong> Right heart catheterization (RHC) via proximal venous access (PVA) like internal jugular, femoral or subclavian is generally a low risk procedure; however, complications may occur and are usually access site related. RHC via antecubital vein access (AVA) gained increased popularity given the lower complications rate.</p> <p><strong>Purpose:</strong> Our aim was to determine the feasibility and safety of AVA to perform RHC as compared to PVA in patients with confirmed or suspected pulmonary hypertension in an expert centre. </p> <p><strong>Methods</strong>: We performed a 9 year retrospective analysis of all patients undergoing right heart catheterization with confirmed or suspected pulmonary hypertension in a single expert centre . Medical records were analysed for demographic and procedural data.</p> <p><strong>Results</strong>: Five hundred and sixty nine (564) patients with a RHC procedures were analysed. The mean age was 58 ± 16 years, with female predominance (68,4%). The access site for the all cohort was PVA in 75,4% of patients (femoral access in 29,9% and a jugular access in 45,4%) and AVA in 24,6%. From 2010 until 2014 the access site was a PVA in 100% of cases. As of 2015 AVA was the preferred site and was obtained in all eligible patients. In the data from 2015 onwards, PVA was obtained in 229 patients (62,7%) and AVA in 136 (37,2%). In 2019, PVA was obtained in 43 patients (57,3%) and AVA in 32 (42,7%).</p> <p>The median time needed for completion of RHC was significantly lower in the AVA group (73 min vs 42 min; Mann Whitney U test p<0,001 ). Fluoroscopy time was similar in the group of patients who underwent the procedure via antecubital access (3,45 min vs. 3,57 min; Mann Whitney U test p = 0,16)</p> <p>The complications rate was 1,1% ( 6 events) in the PVA group compared with 0,4% (2 events) in the AVA group, without statistical difference.</p> <p>Patients could be discharged in one hour after the procedure in the antecubital approach, opposing to 3 hours after jugular approach and 6 hours after femoral approach as by protocol in our institution. </p> <p><strong>Conclusions</strong>: The feasibility of RHC performed by AVA is dependent on the volume of the centre. Our experience demonstrates a learning curve with increasing success rate (currently with a feasibility of about 40%) and support the use of this approach due to less procedural time and a faster resumption of ambulation without any serious adverse event.</p>
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