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Scherer, Clemens; Theiss, Hans; Istrefi, Mario; Binzenhöfer, Leonhard; Kupka, Danny; Stocker, Thomas; Lüsebrink, Enzo; Stambollxhiu, Era; Alemic, Ahmed; Petzold, Tobias; Stark, Konstantin; Deseive, Simon; Braun, Daniel; Joskowiak, Dominik; Peterss, Sven; Hausleiter, Jörg; Hagl, Christian; Massberg, Steffen; Orban, Martin (2023): Suture-based vs. pure plug-based vascular closure devices for VA-ECMO decannulation–A retrospective observational study. Frontiers in Cardiovascular Medicine, 10. ISSN 2297-055X

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Abstract

Suture-based vs. pure plug-based vascular closure devices for VA-ECMO decannulation–A retrospective observational study Clemens Scherer Hans Theiss Mario Istrefi Leonhard Binzenhöfer Danny Kupka Thomas Stocker Enzo Lüsebrink Era Stambollxhiu Ahmed Alemic Tobias Petzold Konstantin Stark Simon Deseive Daniel Braun Dominik Joskowiak Sven Peterss Jörg Hausleiter Christian Hagl Steffen Massberg Martin Orban Background

Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a valuable treatment option for patients in cardiogenic shock, but complications during decannulation may worsen the overall outcome. Therefore, the aim of this study was to compare the efficacy and safety of suture-based to pure plug-based vascular closure devices for VA-ECMO decannulation.
Methods

In this retrospective study, the procedural outcome of 33 patients with suture-based Perclose ProGlide closure devices was compared to 38 patients with MANTA plug-based closure devices.
Results

Rate of technically correct placement of closure devices was 88% in the suture-based group and 97% in the plug-based group ( p = 0.27). There was a significant reduction of severe bleeding events during VA-ECMO decannulation in plug-based versus suture-based systems (3% vs. 21%, p = 0.04). Ischemic complications occurred in 6% with suture-based and 5% with plug-based device ( p = 1.00). Pseudoaneurysm formation was detected in 3% in both groups ( p = 1.00). No switch to vascular surgery due to bleeding after decannulation was necessary in both groups.
Conclusion

Based on our retrospective analysis, we propose that plug-based vascular closure should be the preferred option for VA-ECMO decannulation. This hypothesis should be further tested in a randomized trial.
1 26 2023 1106114 10.3389/fcvm.2023.1106114 1 10.3389/crossmark-policy frontiersin.org true Deutsche Forschungsgemeinschaft http://dx.doi.org/10.13039/501100001659 Ludwig-Maximilians-Universität München http://dx.doi.org/10.13039/501100005722 https://creativecommons.org/licenses/by/4.0/ 10.3389/fcvm.2023.1106114 https://www.frontiersin.org/articles/10.3389/fcvm.2023.1106114/full https://www.frontiersin.org/articles/10.3389/fcvm.2023.1106114/full EuroIntervention. Holger 17 451 2021 10.4244/EIJ-D-20-01296 Management of cardiogenic shock. JAMA. Samsky 326 1840 2021 Cardiogenic shock after acute myocardial infarction: a review. 10.4244/EIJ-D-20-01296 Ann Thorac Surg. Cheng 97 610 2014 Complications of extracorporeal membrane oxygenation for treatment of cardiogenic shock and cardiac arrest: a meta-analysis of 1,866 adult patients. 10.1001/jama.2021.18323 Cardiovasc Revasc Med Dumpies 37 34 2022 Manta versus perclose proglide vascular closure device after transcatheter aortic valve implantation: initial experience from a large European center. 10.1016/j.carrev.2021.06.134 Perfusion. Au 36 803 2021 10.1177/0267659120971998 One-year experience of bedside percutaneous VA-ECMO decannulation in a high-ECMO-volume center in Hong Kong. Can J Cardiol. Montero-Cabezas 35 796.e9 2019 Percutaneous decannulation of femoral venoarterial ECMO cannulas using MANTA vascular closure device. 10.1177/0267659120971998 Thorac Cardiovasc Surg. Pingpoh 69 537 2021 Efficacy of vascular closure devices in closing large-bore sheath arterial sites after treatment with extracorporeal life support system. 10.1016/j.cjca.2019.02.010 Eur Heart J. Ponikowski 37 2129 2016 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: the task force for the diagnosis and treatment of acute and chronic heart failure of the European society of cardiology (ESC)developed with the special contribution of the heart failure association (HFA) of the ESC. 10.1055/s-0041-1728708 N Engl J Med. Thiele 367 1287 2012 Intraaortic balloon support for myocardial infarction with cardiogenic shock. 10.1093/eurheartj/ehw128 N Engl J Med. Thiele 379 1699 2018 One-year outcomes after PCI strategies in cardiogenic shock. 10.1056/NEJMoa1208410 Crit Care Explor. Lusebrink 1 e0018 2019 Percutaneous decannulation instead of surgical removal for weaning after venoarterial extracorporeal membrane oxygenation-A crossed perclose proglide closure device technique using a hemostasis valve Y connector. 10.1056/NEJMoa1808788 Ann Intern Med. von Elm 147 573 2007 The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. 10.1097/CCE.0000000000000018 J Interv Cardiol. Scherer 2022 9915247 2022 Manual compression versus suture-mediated closure device technique for VA-ECMO decannulation. 10.7326/0003-4819-147-8-200710160-00010 Circulation. Abdel-Wahab 145 170 2022 Comparison of a pure plug-based versus a primary suture-based vascular closure device strategy for transfemoral transcatheter aortic valve replacement: the CHOICE-CLOSURE randomized clinical trial. 10.1155/2022/9915247 Indian Heart J. Mahalwar 74 251 2022 Meta-analysis of PROGLIDE versus MANTA vascular closure devices for large-bore access site management. 10.1161/CIRCULATIONAHA.121.057856 Image_1.JPEG 10.3389/fcvm.2023.1106114.s001 https://www.frontiersin.org/articles/10.3389/fcvm.2023.1106114/supplementary-material/10.3389/fcvm.2023.1106114.s001

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