Percutaneous decannulation of extracorporeal membrane oxygenation using a plug-based closure device

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Vascular Surgery

Background:

• Limited data exists on the use of the MANTA plug-based vascular closure device for femoral artery closure post-venoarterial extracorporeal membrane oxygenation (VA ECMO).
• Percutaneous decannulation is a critical step in VA ECMO management.

Purpose of the Study:

• To evaluate femoral artery complications and the need for vascular interventions after percutaneous decannulation of VA ECMO using the MANTA device.
• To identify the types of vascular complications associated with this procedure.

Main Methods:

• A study of 34 consecutive patients undergoing percutaneous decannulation of VA ECMO with the MANTA device.
• Primary outcomes included conversion to surgical cutdown, and secondary outcomes were the types of vascular complications necessitating conversion.

Main Results:

• Six patients (17.7%) required conversion to surgical cutdown, either immediately or late.
• Complications included common femoral artery occlusion (n=3) and bleeding/pseudoaneurysm (n=3).
• MANTA device failure modes included intravascular deployment, incomplete sealing, and unrelated thrombosis.

Conclusions:

• Percutaneous decannulation of VA ECMO with the MANTA vascular closure device is feasible but associated with a significant rate of unplanned surgical repair.
• High rates of stenosis/occlusion or bleeding necessitate a low threshold for conversion to surgical cutdown if suboptimal MANTA positioning is suspected.