Complete percutaneous decannulation from femoral venoarterial extracorporeal membrane oxygenation

Abstract

Objectives: To evaluate the clinical outcomes and perioperative complications associated with complete percutaneous decannulation of femoral venoarterial extracorporeal membrane oxygenation (VA-ECMO) with the MANTA closure device.Methods: This is a retrospective analysis of a single surgeon consecutive series of 14 patients at a single center who underwent decannulation from VA-ECMO, 10 of whom underwent a percutaneous method of femoral cannula removal.Results: After a mean duration of VA-ECMO support of 7.4 AE 3.8 days, all 10 patients, with arterial cannulas ranging in size from 17 to 21 Fr, underwent percutaneous decannulation with the MANTA closure device, with immediate hemostasis. One patient had acute lower limb ischemia that was recognized intraoperatively and successfully treated with suction embolectomy. Two patients had a pseudoaneurysm at the distal perfusion catheter site recognized on perioperative imaging studies, one resolving with observation and the other necessitating thrombin injection. One patient had a hematoma that resolved with observation.Conclusions: Percutaneous decannulation from VA-ECMO using the MANTA largebore vascular closure device is feasible and results in immediate hemostasis with excellent angiographic results. (JTCVS Techniques 2021;6:75-81) MANTA closure device deployed for percutaneous closure of a femoral arterial cannulation site.

Preclosure technique versus arterial cutdown after percutaneous cannulation for venoarterial extracorporeal membrane oxygenation

“…However, these techniques have not yet demonstrated improvements in clinical outcomes compared with surgical removal in this setting. [4][5][6][7][8] We suspect postclosure compared with preclosure may result in a more technically challenging VA-ECMO decannulation procedure and be prone to excessive blood loss when attempting to deploy the suture device after large-bore arterial access such as provided with VA-ECMO. It has been suggested that a possible…”

“…However, these techniques have not yet demonstrated improvements in clinical outcomes compared with surgical removal in this setting. 4 , 5 , 6 , 7 , 8 We suspect postclosure compared with preclosure may result in a more technically challenging VA-ECMO decannulation procedure and be prone to excessive blood loss when attempting to deploy the suture device after large-bore arterial access such as provided with VA-ECMO. It has been suggested that a possible advantage of the postclosure technique compared with preclosure in VA-ECMO is that, given the uncertain duration of extracorporeal therapy, suture-mediated system stitches may remain in place and be subject to infection for prolonged periods of time.…”

“… 3 In an effort to reduce the rates of vascular complications at the time of VA-ECMO decannulation and to avoid the need for traditional surgical vascular repair, percutaneous techniques for closure of arterial cannulation sites utilizing suture-mediated closure systems have been employed by a number of centers. 4 , 5 , 6 , 7 , 8 Likewise, suture-mediated closures systems have been utilized for safe and successful closure of large-bore venous and arterial access sites following a variety of elective vascular procedures including the elective use of VA-ECMO before lung transplantation. 9 , 10 , 11 , 12 , 13 , 14 The Perclose ProGlide (Abbott Vascular, Abbott Park, Ill) is 1 such suture-mediated closure system.…”

Commentary: MANTA could be an ace in the hole for peripheral extracorporeal membrane oxygenation

“…The University of Maryland Medical Center Extracorporeal Membrane Oxygenation (ECMO) group is to be congratulated for their innovation in tackling one of the most annoying problems encountered in the patient with cardiopulmonary failure. 1 At the risk of ignoring the insights from Tversky and Kahneman in their 1971 manuscript on “Belief in the Law of Small Numbers,” 2 I would propose that deploying the MANTA (Teleflex, Morrisville, NC) in the ex post management of percutaneous cannulation represents a promising strategy for future study. As we celebrate the use of this beautiful new mouse trap, I think it is important to consider the question of how we found ourselves with a rodent infestation in the first place.…”

Commentary: MANTAstic!

“…In this issue of the Journal , Shah and colleagues 1 from University of Maryland report on their retrospective observational experience with decannulation of extracorporeal membrane oxygenation (ECMO) support using the MANTA large-bore vascular closure device. The study details their experience with 10 consecutive patients who underwent decannulation using the device.…”