Division of Cardiovascular and Structural Heart Disease, Lankenau Medical Center and Lankenau Institute of Medical Research, Wynnewood, PA, United States of America.
Division of Cardiovascular and Structural Heart Disease, Lankenau Medical Center and Lankenau Institute of Medical Research, Wynnewood, PA, United States of America.
Cardiovasc Revasc Med. 2023 Jun;51:45-51. doi: 10.1016/j.carrev.2023.01.030. Epub 2023 Feb 3.
Large bore arterial hemostasis for emergent MCS initiation in cardiogenic shock and during failures of suture mediated vascular closure devices (VCD) necessitates dry/post-closure technique for successful closure. Use of the alternative MANTA fluoroscopic DOT technique, without depth finder, as post closure and as 'bail-out' in this high-risk patient population is described.
All patients who underwent emergent percutaneous transfemoral MCS initiation, without use of upfront sutured-mediated pro-glide VCDs, and procedures where proglide-perclose technique (PPT) failed to achieve hemostasis were post-closed with the alternative MANTA fluoroscopic DOT technique (without depth finder) as primary method or as 'bail-out'. Patient related factors, cardiovascular co-morbidities, clinical indication, distribution of 14F versus 18F MANTA, and types of procedures obtained. Primary outcomes of access site related acute flow-limiting limb ischemia or bleeding requiring intervention analyzed.
27 patients met inclusion criteria; mean age 64 years, majority male 19 (70 %), more than half obese (56 %) with mean BMI 31.06 kg/m. 22 (81 %) had emergent MCS initiation and 5 (19 %) PPT hemostasis failures. Types of percutaneous MCS support included; 11 (44 %) Impella CP, 2 (7 %) 15F arterial ECMO, 6 (22 %) 17F arterial ECMO, 4 (15 %) 19F ECMO. All achieved hemostasis utilizing alternative MANTA fluoroscopic DOT technique without vascular complications of bleeding or acute ischemic limb.
The alternative MANTA fluoroscopic DOT technique (without depth finder) can be successfully applied as post-closure for emergent MCS support delayed hemostasis and as bail-out for per-close suture mediated VCD failures for large bore arterial hemostasis.
在心源休克和缝合介导的血管闭合装置（VCD）故障期间，为了紧急启动 MCS，需要进行大口径动脉止血，这需要使用干燥/闭合后技术来实现成功闭合。本文描述了在这种高风险患者人群中，替代 MANTA 荧光透视 DOT 技术（无深度探测器）在闭合后和作为“紧急备用”的应用。
所有接受紧急经皮股动脉 MCS 启动的患者，均未使用前置缝合介导的 pro-glide VCD，并在 proglide-perclose 技术（PPT）未能实现止血的情况下，使用替代 MANTA 荧光透视 DOT 技术（无深度探测器）作为主要方法或作为“紧急备用”进行闭合。分析患者相关因素、心血管合并症、临床适应证、14F 与 18F MANTA 的分布以及获得的手术类型。分析与入路相关的急性血流受限肢体缺血或需要干预的出血等主要结局。
27 名患者符合纳入标准；平均年龄 64 岁，大多数为男性 19 名（70%），超过一半为肥胖患者（56%），平均 BMI 为 31.06kg/m。22 名（81%）患者为紧急 MCS 启动，5 名（19%）PPT 止血失败。经皮 MCS 支持的类型包括：11 名（44%）Impella CP、2 名（7%）15F 动脉 ECMO、6 名（22%）17F 动脉 ECMO、4 名（15%）19F ECMO。所有患者均成功使用替代 MANTA 荧光透视 DOT 技术实现止血，无出血或急性缺血性肢体血管并发症。
替代 MANTA 荧光透视 DOT 技术（无深度探测器）可成功应用于紧急 MCS 支持延迟止血的闭合后，以及用于大口径动脉止血的闭合后缝合介导的 VCD 失败的紧急备用。
