Femoral Access with Ultrasound-Guided Puncture and Z-Stitch Hemostasis for Adults with Congenital Heart Diseases Undergoing Electrophysiological Procedures

Aims: Although the application of ultrasound-guided vascular puncture and Z-stitch hemostasis to manage femoral access has been widely utilized, there is limited data on this combined application in adult congenital heart disease (ACHD) patients undergoing electrophysiological (EP) procedures. We sought to evaluate the safety and efficacy of ultrasound-guided puncture and postprocedural Z-stitch hemostasis for ACHD patients undergoing EP procedures. Methods and Results: The population of ACHD patients undergoing transfemoral EP procedures at the University of Zurich Heart Center between January 2019 and December 2022 was observed and analyzed. During the study period, femoral access (left/right, arterial/venous) was performed under real-time ultrasound guidance. At the end of the procedure, a single Z-stitch was performed at the puncture site. We evaluated the incidence of in-hospital complications associated with femoral access puncture in this population. Among 101 patients who had a total of 147 previous ipsilateral vascular punctures (mean 1.5 per person), 100 patients underwent successful femoral vascular access for EP procedures. The median age of the patients was 47 ± 15 years and 34 (34%) were male. Z-stitches were performed after the procedure in 100 patients with 303 femoral vascular accesses (mean 3 punctures per person). No patient developed vascular puncture relevant inguinal hematoma, pseudo aneurysm, arteriovenous fistula, venous or arterial thrombosis. Conclusion: In ACHD patients undergoing EP procedures, optimal femoral access management can be achieved with ultrasound-guided puncture and postprocedural Z-stitch hemostasis.