Efficacy, safety, and complications of manta vascular closure device in VA-ECMO decannulation: A systematic review and meta-analysis

Abstract

Background: VenoArterial (VA)-ExtraCorporeal Membrane Oxygenation (ECMO) decannulation was traditionally performed surgically, often resulting in high rates of periprocedural complications such as surgical site infections, bleeding, and elevated patient mobilization costs. The advent of percutaneous techniques, particularly the MANTA^® vascular closure device (MVCD), has significantly reduced these risks by enabling faster and safer decannulation. This study aimed to systematically review the success rates and complications associated with the use of percutaneous closure devices for VA-ECMO decannulation.

Objective: Therefore, this systematic review with meta-analysis aims to evaluate the success rates and complications associated with the use of MVCD device for VA-ECMO decannulation.

Materials and methods: A systematic search was conducted across Pubmed, Web of Science, and Cochrane databases to identify studies evaluating postoperative outcomes in patients undergoing VA-ECMO decannulation using the MANTA^® vascular closure device. The MANTA^® efficacy, incidence of emergent open repair, arterial thrombosis, acute limb ischemia, pseudoaneurysms, and major bleeding were pooled by fixed-effects meta-analysis, with sources of heterogeneity being explored by meta-regression. Assessment of studies' quality was performed using the National Heart, Lung, and Blood Institute (NHLBI) Study Quality Assessment Tool for observational cohorts and case-series studies.

Results: Seven observational studies with 235 patients were included in the final analysis. Overall efficacy of MVCD in VA-ECMO decannulation was 94.8% (95% CI 91.8%-97.9%). In 235 patients, the incidence of emergency open repair after MVCD failure was 3.7% (95% CI 1.3%-6.1%), the incidence of arterial thrombosis was 7.1% (95% CI 2.9%-11.3%), the incidence of pseudoaneurysms was 3.2% (95% CI 0.9%-5.5%), the incidence of acute limb ischemia was 5.0% (95% CI 2.3%-7.8%), and the incidence of major arterial bleeding was 4.1% (95% CI 1.6%-6.7%).

Conclusion: This systematic review and meta-analysis highlights the safety and efficacy of the MANTA^® vascular closure device in achieving hemostasis following VA-ECMO decannulation, demonstrating an acceptable success rate and a low incidence of major complications. Further studies with larger cohorts are necessary to validate these findings and to address the limitations of this preliminary experience.

Keywords: Arterial puncture closure; closure device; collagen plug; mechanical circulatory support; venoarterial extracorporeal membrane oxygenation.