Three‐way stopcock suture technique for hemostasis after ablation for atrial fibrillation

Payne, Jason; Aznaurov, Samuel; Gautam, Sandeep

doi:10.1111/jce.13712

Cited by 10 publications

(15 citation statements)

References 8 publications

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“…Our data suggest that with the use of the F8S and SCT, adequate hemostasis can be obtained without protamine for heparin reversal. These novel techniques have been previously shown to reduce the time needed for hemostasis, extubation, and transport out of the laboratory when compared to MC . In our study, no difference was observed in hemostasis effectiveness or complications between patients receiving F8S or SCT closure.…”

Section: Discussionmentioning

confidence: 46%

“…In our study, we did not observe any deep bleeding and only a single suture failure. We have previously described in detail the correct technique for SCT hemostasis . The combination of these closure techniques as well as withholding protamine could be stipulated to reduce both recovery time as well as morbidity related to protamine use.…”

Section: Discussionmentioning

confidence: 99%

“…The SCT is a modification of the F8S. It has also been previously described in detail . Similar to the F8S, a needle pass is made both distally and proximally to the sheath location.…”

Section: Methodsmentioning

confidence: 99%

“…Historically, manual compression (MC) of the venous access site was used for achieving postoperative hemostasis when the ACT is at a lower level (typically below 200 seconds). More recently, alternative suture techniques have become increasingly popular due to faster hemostasis following sheath removal, including the figure‐of‐eight suture (F8S) and the three‐way stopcock technique (SCT) . With these newer techniques, the administration of protamine may not be necessary to facilitate safe sheath removal.…”

Section: Introductionmentioning

confidence: 99%

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Heparin reversal with protamine sulfate is not required in atrial fibrillation ablation with suture hemostasis

Yasar

Bickel

Zhang

et al. 2019

Cardiovasc electrophysiol

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Background The utility of protamine sulfate for heparin reversal in catheter‐based atrial fibrillation (AF) ablation is unclear when using the suture closure technique for vascular hemostasis. Objective This study sought to address if protamine sulfate use for heparin reversal reduces vascular access complications in AF catheter ablation when suture techniques are used for postprocedural vascular hemostasis. Methods This is a retrospective multicenter observational study of 294 consecutive patients who underwent catheter ablation for AF with subsequent vascular access hemostasis by means of a figure‐of‐eight suture or stopcock technique. A total of 156 patients received protamine for heparin reversal before sheath removal while 138 patients did not receive protamine. The two groups were compared for procedural activated clotting time (ACT), access site complications, and duration of hospital stay. Results Baseline demographic characteristics were comparable in both groups. Despite higher ACT before venous sheath removal in patients not receiving protamine (288.0 ± 44.3 vs 153.9 ± 32.0 seconds; P < .001), there was no significant difference in groin complications, postoperative thromboembolic events, or duration of hospital stay between the two groups. Suture failure requiring manual compression was rarely observed in this cohort (0.34%). Conclusion With modern vascular access and sheath management techniques, for patients undergoing catheter ablation for AF, simple suture closure techniques can obviate the need for protamine administration to safely achieve hemostasis after removal of vascular sheaths.

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Section: Discussionmentioning

confidence: 46%

Section: Discussionmentioning

confidence: 99%

“…The SCT is a modification of the F8S. It has also been previously described in detail . Similar to the F8S, a needle pass is made both distally and proximally to the sheath location.…”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Heparin reversal with protamine sulfate is not required in atrial fibrillation ablation with suture hemostasis

Yasar

Bickel

Zhang

et al. 2019

Cardiovasc electrophysiol

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“…Recently, the figure‐of‐eight suture technique has become a more widely used alternative as it has been shown to be as safe and effective as manual compression . An innovative twist on this technique is the use of a stopcock device to apply tension on venous access site suture in lieu of the figure‐of‐eight suture knot for hemostasis after radiofrequency catheter ablation of atrial fibrillation . Here, we describe the use of a 0.035” in torque device (Boston Scientific, Marlborough, MA and Terumo Interventional Systems, Somerset, NJ) as an alternative to the stopcock device or suture knot to apply tension on figure‐of‐eight sutures.…”

Section: Introductionmentioning

confidence: 99%

Torque device suture technique to achieve hemostasis in large‐bore venous access

Karahalios

Rojas

Singh

et al. 2019

Cathet Cardio Intervent

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Objectives To describe and compare a novel technique using a torque device to manage figure‐of‐eight suture tension for venous access hemostasis in patients who have undergone atrial septal defect (ASD) or patent foramen ovale (PFO) closure. Background Large bore venous access has become increasingly important in transcatheter procedures, but management of hemostasis can be time‐consuming and/or resource intensive. As such, various techniques have sought to provide cost effective and safe alternatives to manual compression. We describe a modification of the figure‐of‐eight suture technique wherein we apply a torque device to manage variable suture tension instead of tying a knot and compare it to the standard figure‐of‐eight suture technique. Methods We performed a retrospective study of 40 consecutive patients who underwent ASD or PFO closure, 20 of whom underwent standard figure‐of‐eight technique and 20 of whom underwent figure‐of‐eight with torque device modification. Bleeding Academic Research Consortium definitions were used to categorize bleeding events. Results The groups were similar in age, gender, weight, aspirin use, platelet count, procedure time, hemoglobin, and international normalized ratio. Standard figure‐of‐eight suture had seven patients with bleeding, with six classified as BARC II and one as BARC I. Figure‐of‐eight plus torque device had three patients with bleeding, with two classified BARC II and one as BARC I. There were no incidences of hematoma in either group. Conclusion The torque device suture technique is a unique modification of the figure‐of‐eight suture technique to achieve venous hemostasis. In addition, the modification allows secure and variable suture tension as well as easy removal by nursing staff.

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Feasibility and safety of same-day discharge and shortened bedrest after atrial fibrillation ablation

Freedman

Yang

Shim

et al. 2022

J Interv Card Electrophysiol

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Background While initial studies suggest that same-day discharge or shortened bedrest may be feasible for some patients following atrial fibrillation (AF) ablation, the risks and benefits of this approach remain unclear for patients undergoing hemostasis with figure-of-eight (FO8) suture technique. Methods We prospectively evaluated access site bleeding, length of hospitalization, urinary catheterization, and other clinical outcomes in patients undergoing AF ablation with 3 hours of bedrest between April and May 2021, and compared them to a control group that had undergone AF ablation with 6 hours of bedrest from April to July 2019. FO8 sutures were used for hemostasis in all patients. Independent risk factors for bleeding and urinary catheterization were determined using multiple logistic regression. Results Same-day discharge was achieved in 74% of patients in the 3-hour bedrest group compared to 7% of patients in the 6-hour bedrest group ( p < 0.001). There were no differences between 3-hour and 6-hour bedrest groups in the rates of serious adverse events (2% vs. 1%, p = 0.45) or rehospitalizations or ED visits (1% vs. 3%, p = 0.45) within 30 days of ablation. The 3-hour bedrest group showed a non-significant trend toward more access site bleeding (15% vs. 8%, p = 0.10), but had a significant reduction in urinary catheterization (27% vs. 64%, p < 0.001) and opioid analgesia use (20% vs. 33%, p = 0.04). Conclusions Same-day discharge after 3 hours of bedrest is safe and feasible following AF ablation and is not associated with higher rates of complications or rehospitalizations at 30 days. Reduced bedrest resulted in decreased opioid analgesia and urinary catheterization. Supplementary Information The online version contains supplementary material available at 10.1007/s10840-022-01255-4.

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Three‐way stopcock suture technique for hemostasis after ablation for atrial fibrillation

Abstract: In this proof-of-concept study, a simple stopcock device provided comparable hemostasis to standard F8S after radiofrequency catheter ablation of AF.

Cited by 10 publications

References 8 publications

Heparin reversal with protamine sulfate is not required in atrial fibrillation ablation with suture hemostasis

Heparin reversal with protamine sulfate is not required in atrial fibrillation ablation with suture hemostasis

Torque device suture technique to achieve hemostasis in large‐bore venous access

Feasibility and safety of same-day discharge and shortened bedrest after atrial fibrillation ablation

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