Percutaneous Femoral Arterial Closure Following Decannulation of Venoarterial Extracorporeal Membrane Oxygenation Using the MANTA Vascular Closure Device.

BACKGROUND: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is a life-saving therapy for patients with severe cardiac failure. If patients can be weaned, withdrawal and closure of the large-bore arterial access are required, which historically have been achieved through surgical closure. The MANTA vascular closure device (VCD) is a percutaneous, collagen-based plug device used following large-bore arterial access. We sought to evaluate the efficacy and safety of the MANTA VCD for percutaneous arterial closure following VA-ECMO decannulation.

METHOD: A non-randomised, open-label pilot study of patients who underwent decannulation from VA-ECMO with percutaneous closure using the MANTA VCD.

RESULTS: Eight patients presenting with cardiogenic shock (mean age 46.5±11.4 years, 37.5% female) underwent percutaneous closure following VA-ECMO decannulation using the 18 Fr MANTA VCD. The mean duration of VA-ECMO support prior to decannulation was 4.8±2.6 days, with arterial cannula sizes ranging from 15 to 19 Fr. There were two major adverse events: one patient had acute limb ischaemia due to superficial femoral artery occlusion, which was detected during percutaneous closure and treated surgically; another patient developed a femoral pseudoaneurysm and infected hematoma that subsequently required surgical repair 17 days after percutaneous closure.

CONCLUSIONS: In a centre with immediate access to vascular surgical backup, and in highly selected patients, percutaneous closure following VA-ECMO decannulation using the MANTA VCD is feasible; however, major vascular complications raise concerns regarding safety prior to its adoption as an alternative to up-front surgical closure.