Innovative technique to achieve hemostasis with large bore access for percutaneous hemodynamic support devices
Patel R, Ali M, Nair S, Alqarqaz M, Koenig G, Zaidan M, Kim H, O'Neill W, Alaswad K. Innovative technique to achieve hemostasis with large bore access for percutaneous hemodynamic support devices. J Am Coll Cardiol. Mar 2017;69(11):1114-1114.
Am Coll Cardiol
Background: The TandemHeart(TH) is a left atrial-to-femoral artery (LA-FA) percutaneous left ventricular assist device (pLVAD) used for hemodynamic supportduring high risk percutaneous coronary intervention (PCI). TH requires large bore venous and arterial sheaths, for which access site complications and management pose a significant challenge. We report a unique method of achieving vascular hemostasisand outcomes after removal of the TH post PCI. Methods: 14 LA-FA THs were placed from September 2015 to October 2016 at Henry Ford Hospital. 9 patients received TH support during complex PCI. Hemodynamic and clinical data, including accessmanagement were collected and analyzed. Results: 9 THs were placed to assist with complex PCI. Mean age and EF was 68.77 ± 16.1 and 29.8% ± 22.6%, respectively. Procedural success and vascular hemostasis was achieved in 100% of patients, with100% 30 day survival. TH was removed immediately after the PCI in all patients. Venous sheaths for all cases were 21Fr in size. Arterial sheaths were 17Fr for 78% of patients and 15Fr for 22% of patients. Venous closure was achieved utilizing manual compression in 23% of patients and pre-closure witha suture mediated vascular closure device (VCD) in 77% of patients. Arterial hemostasis was achieved using pre-closure with a Perclose VCD in conjunction with an 8Fr Angio-Seal, where a 0.035” wire was introduced through the arterial cannula by puncturing through the cannula wall and was used to deploy an 8 Fr. AngioSeal device before final cinching of the Perclose VCD sutures. Ipsilateral proximal artery balloon tamponade was additionally used in in 45% of patients with an average tamponade time 67.5 seconds. Heparin was used in 89% patients Bivalirudin in 11% with an average peak ACT of 366.7 seconds. Mean duration of TH supportwas 165.25 ± 130 minutes. Hematuria requiring transfusion occurred in 1 patient and minor vascular complication (hematoma) occurred in 1 patient. Conclusions: Percutaneous closure of large borevascular access required of the TH pLVAD is safe and provides successful hemostasis by instituting an innovative combination of 8 Fr. Angio-Seal in addition to pre-closure with Perclose VCD devices.