Using Upper Arm Vein as Temporary Pacemaker Access Site: A Next Step in Minimizing the Invasiveness of Transcatheter Aortic Valve Replacement
<b>Background</b> 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...
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| Format: | Article |
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MDPI AG
2024-01-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/13/3/651 |
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| author | Maxim J. P. Rooijakkers Geert A. A. Versteeg Marleen H. van Wely Laura Rodwell Lokien X. van Nunen Robert Jan van Geuns Leen A. F. M. van Garsse Guillaume S. C. Geuzebroek Michel W. A. Verkroost Robin H. Heijmen Niels van Royen |
| author_facet | Maxim J. P. Rooijakkers Geert A. A. Versteeg Marleen H. van Wely Laura Rodwell Lokien X. van Nunen Robert Jan van Geuns Leen A. F. M. van Garsse Guillaume S. C. Geuzebroek Michel W. A. Verkroost Robin H. Heijmen Niels van Royen |
| author_sort | Maxim J. P. Rooijakkers |
| collection | DOAJ |
| description | <b>Background</b> 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. <b>Methods</b> 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. <b>Results</b> 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%, <i>p</i> = 0.003). Time to mobilization was significantly longer (<i>p</i> < 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%, <i>p</i> = 0.10). Time to mobilization was significantly shorter (480 vs. 1140 min, <i>p</i> < 0.001) in the upper arm cohort, with a comparable skin-to-skin time (83 vs. 85 min, <i>p</i> = 0.75). Cross-over from upper arm pacemaker access was required in 17 patients (6.3% of attempted cases via an upper arm vein). <b>Conclusions</b> 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. |
| first_indexed | 2024-03-08T03:54:27Z |
| format | Article |
| id | doaj.art-3820dee7046a405ca8133ba60ec62dae |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-08T03:54:27Z |
| publishDate | 2024-01-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-3820dee7046a405ca8133ba60ec62dae2024-02-09T15:15:26ZengMDPI AGJournal of Clinical Medicine2077-03832024-01-0113365110.3390/jcm13030651Using Upper Arm Vein as Temporary Pacemaker Access Site: A Next Step in Minimizing the Invasiveness of Transcatheter Aortic Valve ReplacementMaxim J. P. Rooijakkers0Geert A. A. Versteeg1Marleen H. van Wely2Laura Rodwell3Lokien X. van Nunen4Robert Jan van Geuns5Leen A. F. M. van Garsse6Guillaume S. C. Geuzebroek7Michel W. A. Verkroost8Robin H. Heijmen9Niels van Royen10Department of Cardiology, Radboud University Medical Center, 6525 GA Nijmegen, The NetherlandsDepartment of Cardiology, Radboud University Medical Center, 6525 GA Nijmegen, The NetherlandsDepartment of Cardiology, Radboud University Medical Center, 6525 GA Nijmegen, The NetherlandsSection Biostatistics, Department of Health Sciences, Radboud Institute for Health Sciences, 6525 EZ Nijmegen, The NetherlandsDepartment of Cardiology, Radboud University Medical Center, 6525 GA Nijmegen, The NetherlandsDepartment of Cardiology, Radboud University Medical Center, 6525 GA Nijmegen, The NetherlandsDepartment of Cardiothoracic Surgery, Radboud University Medical Center, 6525 GA Nijmegen, The NetherlandsDepartment of Cardiothoracic Surgery, Radboud University Medical Center, 6525 GA Nijmegen, The NetherlandsDepartment of Cardiothoracic Surgery, Radboud University Medical Center, 6525 GA Nijmegen, The NetherlandsDepartment of Cardiothoracic Surgery, Radboud University Medical Center, 6525 GA Nijmegen, The NetherlandsDepartment of Cardiology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands<b>Background</b> 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. <b>Methods</b> 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. <b>Results</b> 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%, <i>p</i> = 0.003). Time to mobilization was significantly longer (<i>p</i> < 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%, <i>p</i> = 0.10). Time to mobilization was significantly shorter (480 vs. 1140 min, <i>p</i> < 0.001) in the upper arm cohort, with a comparable skin-to-skin time (83 vs. 85 min, <i>p</i> = 0.75). Cross-over from upper arm pacemaker access was required in 17 patients (6.3% of attempted cases via an upper arm vein). <b>Conclusions</b> 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.https://www.mdpi.com/2077-0383/13/3/651aortic stenosisbleeding complicationspacemakertranscatheter aortic valve replacement |
| spellingShingle | Maxim J. P. Rooijakkers Geert A. A. Versteeg Marleen H. van Wely Laura Rodwell Lokien X. van Nunen Robert Jan van Geuns Leen A. F. M. van Garsse Guillaume S. C. Geuzebroek Michel W. A. Verkroost Robin H. Heijmen Niels van Royen Using Upper Arm Vein as Temporary Pacemaker Access Site: A Next Step in Minimizing the Invasiveness of Transcatheter Aortic Valve Replacement Journal of Clinical Medicine aortic stenosis bleeding complications pacemaker transcatheter aortic valve replacement |
| title | Using Upper Arm Vein as Temporary Pacemaker Access Site: A Next Step in Minimizing the Invasiveness of Transcatheter Aortic Valve Replacement |
| title_full | Using Upper Arm Vein as Temporary Pacemaker Access Site: A Next Step in Minimizing the Invasiveness of Transcatheter Aortic Valve Replacement |
| title_fullStr | Using Upper Arm Vein as Temporary Pacemaker Access Site: A Next Step in Minimizing the Invasiveness of Transcatheter Aortic Valve Replacement |
| title_full_unstemmed | Using Upper Arm Vein as Temporary Pacemaker Access Site: A Next Step in Minimizing the Invasiveness of Transcatheter Aortic Valve Replacement |
| title_short | Using Upper Arm Vein as Temporary Pacemaker Access Site: A Next Step in Minimizing the Invasiveness of Transcatheter Aortic Valve Replacement |
| title_sort | using upper arm vein as temporary pacemaker access site a next step in minimizing the invasiveness of transcatheter aortic valve replacement |
| topic | aortic stenosis bleeding complications pacemaker transcatheter aortic valve replacement |
| url | https://www.mdpi.com/2077-0383/13/3/651 |
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