Decannulation of peripheral VA ECMO with Manta percutaneous closure device: experience of a center

Peripheral venoarterial extracorporeal membrane oxygenator (VA ECMO) requires cannulation of a large-bore femoral arterial access, leading to frequent vascular complications, with decannulation being one of the most critical moments. Traditionally, decannulation has predominantly been performed surgically. In the field of structural interventionism, there is already broad experience in the use of percutaneous closure devices (PCD) based on collagen plugs, such as the Manta one. Nevertheless, its application in ECMO cannula removal is not yet widely established.

We report our center's experience with the Manta device for VA ECMO arterial decannulation, focusing on the occurrence of vascular complications.

We retrospectively collected data from patients who underwent successful decannulation of peripheral VA ECMO between January 2020 and September 2024. Implantation was consistently performed in the cath-lab, while decannulation could be performed percutaneously or surgically, depending on availability and treating medical team's discretion. Patients who underwent percutaneous decannulation with Manta were selected for analysis.

Out of a total of 65 patients, 38 underwent decannulation (58.5%), which was performed with the Manta PCD in 29 patients (76.3%) and surgically in 8 (21.0%). Table 1 presents the characteristics of those patients in whom Manta device was used. The arterial cannula size was 15 French in 86.2%, while the venous cannula size was 21 French in 89.7%. Two patients (6.9%) required distal perfusion due to limb ischemia. After a median of 5.8 days on ECMO, support was removed in the cath-lab in 62.1% of patients and at bedside in 37.9%. The survival rate at hospital discharge was 82.8% in this group.

In 3 patients (10.3%), complications occurred during arterial decannulation: two (6.9%) experienced femoral artery occlusion due to intraluminal release of the PCD, necessitating urgent surgery; and one patient presented major bleeding (BARC 3a) upon removal of the arterial cannula, prior to Manta deployment (with no subsequent device failure). A case of pseudoaneurysm of the femoral artery was detected, requiring surgery 19 days after decannulation; while another patient, who had already experienced femoral artery occlusion due to the Manta, required urgent fasciotomy 3 days later because of compartment syndrome. In patients undergoing surgical decannulation, vascular complications were relatively higher (Table 2). No vascular access infection was recorded in the Manta group. Moreover, there were no complications in patients in whom withdrawal was performed at bedside.