Suture-based vs. pure plug-based vascular closure devices for VA-ECMO decannulation-A retrospective observational...

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Critical Care Medicine

Background:

• Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is crucial for cardiogenic shock.
• Complications during VA-ECMO decannulation can negatively impact patient outcomes.
• Effective vascular closure is essential for safe VA-ECMO removal.

Purpose of the Study:

• To compare the efficacy and safety of suture-based versus plug-based vascular closure devices for VA-ECMO decannulation.
• To evaluate bleeding events, ischemic complications, and pseudoaneurysm formation.
• To determine the preferred method for vascular closure post-VA-ECMO.

Main Methods:

• Retrospective study comparing 33 patients with suture-based closure devices (Perclose ProGlide) and 38 patients with plug-based closure devices (MANTA).
• Analysis of procedural outcomes, including device placement success, bleeding, ischemia, and pseudoaneurysm.
• Statistical comparison of complication rates between the two closure device groups.

Main Results:

• Technically correct device placement rates were 88% for suture-based and 97% for plug-based (p=0.27).
• Severe bleeding events were significantly reduced with plug-based devices (3%) compared to suture-based devices (21%) (p=0.04).
• Ischemic complications (6% vs. 5%) and pseudoaneurysm formation (3% vs. 3%) were similar between groups (p=1.00).

Conclusions:

• Plug-based vascular closure devices are associated with a significant reduction in severe bleeding during VA-ECMO decannulation.
• Plug-based closure should be considered the preferred option for VA-ECMO decannulation.
• Further validation through a randomized controlled trial is recommended.