Abstract：
OBJECTIVE: Right heart catheterization (RHC) is a common diagnostic tool and of special importance in the diagnosis of pulmonary hypertension (PH). Until today, there have been no clear instructions or guidelines on which venous access to prefer. This meta-analysis assessed whether the choice of the venous access site for elective RHC has an impact on procedural or clinical outcomes.
METHODS: A structured literature search was performed. Single-arm reports and controlled trials reporting event data were eligible. The primary endpoint was a composite of access-related and overall complications.
RESULTS: Nineteen studies, including 6509 RHC procedures, were eligible. The results were analyzed in two groups. The first group compared central venous access (CVA; n = 2072) with peripheral venous access (PVA; n = 2680) and included only multi-arm studies (n = 12, C/P comparison). In the second group, all studies (n = 19, threeway comparison) were assessed to compare the three individual access ways. The overall complication rate was low at 1.0% (n = 68). The primary endpoint in the C/P comparison occurred significantly less for PVA than for CVA (0.1% vs. 1.2%; p = 0.004). In the threeway comparison, PVA had a significantly lower complication rate than femoral access (0.3% vs. 1.1%; p = 0.04). Jugular access had the numerically highest complication rate (2.0%), but the difference was not significant compared to peripheral (0.3%; p = 0.29) or femoral access (1.1%; p = 0.32).
CONCLUSIONS: This meta-analysis showed that PVA for RHC has a significantly lower complication rate than CVA. There was a low level of certainty and high heterogeneity. This pooled data analysis indicated PVA as the primary venous access for RHC.
METHODS: A structured literature search was performed. Single-arm reports and controlled trials reporting event data were eligible. The primary endpoint was a composite of access-related and overall complications.
RESULTS: Nineteen studies, including 6509 RHC procedures, were eligible. The results were analyzed in two groups. The first group compared central venous access (CVA; n = 2072) with peripheral venous access (PVA; n = 2680) and included only multi-arm studies (n = 12, C/P comparison). In the second group, all studies (n = 19, threeway comparison) were assessed to compare the three individual access ways. The overall complication rate was low at 1.0% (n = 68). The primary endpoint in the C/P comparison occurred significantly less for PVA than for CVA (0.1% vs. 1.2%; p = 0.004). In the threeway comparison, PVA had a significantly lower complication rate than femoral access (0.3% vs. 1.1%; p = 0.04). Jugular access had the numerically highest complication rate (2.0%), but the difference was not significant compared to peripheral (0.3%; p = 0.29) or femoral access (1.1%; p = 0.32).
CONCLUSIONS: This meta-analysis showed that PVA for RHC has a significantly lower complication rate than CVA. There was a low level of certainty and high heterogeneity. This pooled data analysis indicated PVA as the primary venous access for RHC.
摘要：
背景：右心导管插入术（RHC）是一种常见的诊断工具，在肺动脉高压（PH）的诊断中特别重要。直到今天，还没有明确的说明或指南关于静脉通路的偏好。
目的：本荟萃分析评估了选择性RHC的静脉通路部位的选择是否对手术或临床结果有影响。
方法：进行结构化文献检索。单组报告和报告事件数据的对照试验符合资格。主要终点是通路相关和总体并发症的复合。
结果：包括6,509例RHC程序在内的19项研究合格。对两组结果进行分析。第一组将中心静脉通路（CVA；n=2,072）与外周静脉通路（PVA；n=2,680）进行比较，仅包括多臂研究（n=12，C/P比较）。在第二组中，对所有研究（n=19，三方比较）进行了评估，以比较三种单独的访问方式。总并发症发生率为1.0%(n=68)。在C/P比较中，PVA的主要终点发生率明显低于CVA(0.1%vs.1.2%；p=0.004）。在三方面比较中，PVA的并发症发生率明显低于股骨入路（0.3％vs.1.1%；p=0.04）。颈静脉入路的并发症发生率最高(2.0%),但与外周（0.3％;p=0.29）或股骨入路（1.1％;p=0.32）相比，差异不显着。
结论：这项荟萃分析显示，PVA用于RHC的并发症发生率明显低于CVA。确定性水平低，异质性高。该汇总数据分析表明PVA是RHC的主要静脉通路。
目的：本荟萃分析评估了选择性RHC的静脉通路部位的选择是否对手术或临床结果有影响。
方法：进行结构化文献检索。单组报告和报告事件数据的对照试验符合资格。主要终点是通路相关和总体并发症的复合。
结果：包括6,509例RHC程序在内的19项研究合格。对两组结果进行分析。第一组将中心静脉通路（CVA；n=2,072）与外周静脉通路（PVA；n=2,680）进行比较，仅包括多臂研究（n=12，C/P比较）。在第二组中，对所有研究（n=19，三方比较）进行了评估，以比较三种单独的访问方式。总并发症发生率为1.0%(n=68)。在C/P比较中，PVA的主要终点发生率明显低于CVA(0.1%vs.1.2%；p=0.004）。在三方面比较中，PVA的并发症发生率明显低于股骨入路（0.3％vs.1.1%；p=0.04）。颈静脉入路的并发症发生率最高(2.0%),但与外周（0.3％;p=0.29）或股骨入路（1.1％;p=0.32）相比，差异不显着。
结论：这项荟萃分析显示，PVA用于RHC的并发症发生率明显低于CVA。确定性水平低，异质性高。该汇总数据分析表明PVA是RHC的主要静脉通路。
