Milioglou Ioannis, Qian Alice, Salerno Pedro Rafael Vieira de Oliveira, Pereira Gabriel Tensol Rodrigues, Palma Dallan Luis Augusto, Gray Kelsey E, Morrison Michael, Abu-Omar Yasir, Eldiasty Mohammad, Baeza Cristian
Department of Cardiology, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, United States.
Department of Surgery, University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, OH 44106, United States.
World J Cardiol. 2024 Oct 26;16(10):574-579. doi: 10.4330/wjc.v16.i10.574.
The MANTA vascular closure device (VCD) represents a novel approach to achieving hemostasis after large-bore femoral access procedures. Numerous clinical studies have evaluated the efficacy of the MANTA device across a range of patient populations undergoing different procedures. However, there is still a paucity of data available concerning the use of MANTA devices in aiding the decannulation of venoarterial extracorporeal membrane oxygenation (VA-ECMO).
To present our single-center experience of utilizing the MANTA VCD in patients undergoing this procedure.
This single-center study included all patients undergoing percutaneous decannulation of femoral VA-ECMO using the MANTA plug-based VCD between January 2021 and October 2023 at University Hospitals Cleveland Medical Center. Inclusion criteria were adult patients who required prolonged (> 24 hours) hemodynamic support with VA-ECMO. Outcomes included all-cause mortality, hemostasis, bleeding, limb ischemia, and site infection.
This is a retrospective cohort study of 19 patients with a mean age of 56.8 years. Twelve of them were males with a mean body mass index of 29. The most common extracorporeal membrane oxygenation indication was acute coronary syndrome complicated by cardiogenic shock at 36.8%. The mean length of intensive care unit stay for these patients was 18.8 ± 8.42 days. Seventeen out of 19 patients survived to discharge. The MANTA device was successfully deployed in 19 patients, with 10 procedures conducted at the bedside and 9 in an operating room setting. Complete hemostasis was achieved within 5 minutes of MANTA deployment in 17 out of 19 patients. In 2 patients manual compression after Manta deployment was required to achieve adequate hemostasis. Additionally, acute lower extremity ischemia was noted in two patients, necessitating endovascular interventions. No infections were reported at the site of MANTA deployment.
Overall, based on our experience and that of other centers, the MANTA VCD has proven to be a simple, safe, and effective percutaneous technique for facilitating in the OR, but most of all it opens the opportunity for bedside VA-ECMO decannulation. Post-decannulation ischemic complications are higher in this series of sick patients when compared with elective procedures like transcatheter aortic valve replacement and endovascular aneurysm repair. Additionally, operators should be mindful of the incidence of ischemic complications. Distal Doppler pulse signals should always be checked, to indicate bailout options when this occurs.
MANTA血管闭合装置（VCD）代表了一种在大口径股动脉穿刺术后实现止血的新方法。众多临床研究评估了MANTA装置在接受不同手术的一系列患者群体中的疗效。然而，关于使用MANTA装置辅助静脉-动脉体外膜肺氧合（VA-ECMO）拔管的数据仍然很少。
介绍我们单中心使用MANTA VCD对接受该手术患者的经验。
这项单中心研究纳入了2021年1月至2023年10月在克利夫兰大学医院医学中心使用基于MANTA封堵器的VCD进行经皮股动脉VA-ECMO拔管的所有患者。纳入标准为需要VA-ECMO进行长时间（>24小时）血流动力学支持的成年患者。结局指标包括全因死亡率、止血、出血、肢体缺血和部位感染。
这是一项对19例患者的回顾性队列研究，平均年龄为56.8岁。其中12例为男性，平均体重指数为29。最常见的体外膜肺氧合适应症是急性冠状动脉综合征并发心源性休克，占36.8%。这些患者在重症监护病房的平均住院时间为18.8±8.42天。19例患者中有17例存活出院。MANTA装置在19例患者中成功部署，其中10例在床边进行，9例在手术室进行。19例患者中有17例在MANTA部署后5分钟内实现了完全止血。2例患者在MANTA部署后需要手动压迫以实现充分止血。此外，2例患者出现急性下肢缺血，需要进行血管内干预。MANTA部署部位未报告感染。
总体而言，基于我们和其他中心的经验，MANTA VCD已被证明是一种简单、安全且有效的经皮技术，便于在手术室进行操作，但最重要的是，它为床边VA-ECMO拔管提供了机会。与经导管主动脉瓣置换和血管内动脉瘤修复等择期手术相比，这组病情较重的患者拔管后缺血并发症更高。此外，操作人员应注意缺血并发症的发生率。应始终检查远端多普勒脉搏信号，以便在发生这种情况时指示补救措施。
