Rooijakkers Maxim J P, Versteeg Geert A A, van Wely Marleen H, Rodwell Laura, van Nunen Lokien X, van Geuns Robert Jan, van Garsse Leen A F M, Geuzebroek Guillaume S C, Verkroost Michel W A, Heijmen Robin H, van Royen Niels
Department of Cardiology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands.
Section Biostatistics, Department of Health Sciences, Radboud Institute for Health Sciences, 6525 EZ Nijmegen, The Netherlands.
J Clin Med. 2024 Jan 23;13(3):651. doi: 10.3390/jcm13030651.
The femoral vein is commonly used as a pacemaker access site during transcatheter aortic valve replacement (TAVR). Using an upper arm vein as an alternative access site potentially causes fewer bleeding complications and shorter time to mobilization. We aimed to assess the safety and efficacy of an upper arm vein as a temporary pacemaker access site during TAVR. We evaluated all patients undergoing TAVR in our center between January 2020 and January 2023. Upper arm, femoral, and jugular vein pacemaker access was used in 255 (45.8%), 191 (34.3%), and 111 (19.9%) patients, respectively. Clinical outcomes were analyzed according to pacemaker access in the overall population and in a propensity-matched population involving 165 upper arm and 165 femoral vein patients. Primary endpoint was Bleeding Academic Research Consortium (BARC) type 2, 3, or 5 pacemaker access site-related bleeding. In the overall population, primary endpoint was lowest for upper arm, followed by femoral and jugular vein access (2.4% vs. 5.8% vs. 10.8%, = 0.003). Time to mobilization was significantly longer ( < 0.001) in the jugular cohort compared with the other cohorts. In the propensity-matched cohort, primary endpoint showed a trend toward lower occurrence in the upper arm compared with the femoral cohort (2.4% vs. 6.1%, = 0.10). Time to mobilization was significantly shorter (480 vs. 1140 min, < 0.001) in the upper arm cohort, with a comparable skin-to-skin time (83 vs. 85 min, = 0.75). Cross-over from upper arm pacemaker access was required in 17 patients (6.3% of attempted cases via an upper arm vein). Using an upper arm vein as a temporary pacemaker access site is safe and feasible. Its use might be associated with fewer bleeding complications and shorter time to mobilization compared with the femoral vein.
在经导管主动脉瓣置换术（TAVR）期间，股静脉通常用作起搏器植入部位。使用上臂静脉作为替代植入部位可能会减少出血并发症，缩短活动时间。我们旨在评估上臂静脉作为TAVR期间临时起搏器植入部位的安全性和有效性。我们评估了2020年1月至2023年1月在我们中心接受TAVR的所有患者。分别有255例（45.8%）、191例（34.3%）和111例（19.9%）患者使用上臂、股静脉和颈静脉进行起搏器植入。根据起搏器植入情况，对总体人群以及涉及165例上臂静脉和165例股静脉患者的倾向匹配人群的临床结局进行了分析。主要终点是出血学术研究联盟（BARC）2型、3型或5型起搏器植入部位相关出血。在总体人群中，上臂植入的主要终点最低，其次是股静脉和颈静脉植入（2.4%对5.8%对10.8%，P = 0.003）。与其他队列相比，颈静脉队列的活动时间明显更长（P < 0.001）。在倾向匹配队列中，与股静脉队列相比，上臂植入的主要终点发生率有降低趋势（2.4%对6.1%，P = 0.10）。上臂队列的活动时间明显更短（480对1140分钟，P < 0.001），皮肤切开至皮肤缝合时间相当（83对85分钟，P = 0.75）。17例患者（通过上臂静脉尝试植入病例的6.3%）需要从上臂起搏器植入部位转换。使用上臂静脉作为临时起搏器植入部位是安全可行的。与股静脉相比，其使用可能与更少的出血并发症和更短的活动时间相关。
