Shah Aakash, Robinson Justin, Leibowitz Joshua, Singireddy Shreya, Levy Lauren, Ghoreishi Mehrdad, Toursavadkohi Shahab, Grazioli Alison, Rabin Joseph, Kaczorowski David, Taylor Bradley, Griffith Bartley P
Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland.
Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland.
Ann Thorac Surg. 2025 Jul;120(1):141-149. doi: 10.1016/j.athoracsur.2024.12.008. Epub 2024 Dec 24.
Traditional decannulation of femoral venoarterial (VA) extracorporeal membrane oxygenation (ECMO) involves femoral cutdown. Percutaneous methods have been developed, but data supporting their use are limited. This study sought to compare the MANTA (Teleflex) vascular closure device with open decannulation.
The study investigators retrospectively reviewed patients decannulated from femoral VA ECMO from January 2018 to January 2023 at our institution (University of Maryland Medical Center, Baltimore, MD). Patients were excluded if cannulation was not percutaneous or if percutaneous decannulation was performed without MANTA use. The primary outcome was lower extremity complications. Closure of the distal perfusion site was compared between superficial femoral artery (SFA) manual pressure and percutaneous closure with MYNX (Cordis) or Angioseal (Terumo Medical Corporation).
A total of 160 patients underwent open decannulation, and 94 patients (30 at bedside) underwent MANTA decannulation. Both groups had 6-day median ECMO support duration. The intraoperative revision rate between MANTA and open decannulation was similar (9 [9.6%] vs 26 [16.4%]; P = .13). Four revisions for MANTA were technical failures in early surgeon experience. In a multivariable model, there was a 46% relative reduction in lower extremity complications with MANTA decannulation compared with open decannulation (26.1% vs 39.6%; odds ratio, 0.54; 95% CI, 0.28-1.00). There was no significant difference in SFA complications between manual pressure and percutaneous closure (14.4% vs 10.7%; odds ratio, 0.71; 95% CI, 0.29-1.76).
There is a significant reduction in lower extremity complications with MANTA decannulation compared with open decannulation from femoral VA ECMO, thus allowing for safe bedside decannulation. Percutaneous SFA closure has outcomes equivalent to those of manual pressure.
传统的股动静脉（VA）体外膜肺氧合（ECMO）拔管需要进行股部切开术。经皮方法已经得到发展，但支持其应用的数据有限。本研究旨在比较MANTA（泰利福）血管闭合装置与开放拔管法。
研究调查人员回顾性分析了2018年1月至2023年1月在我们机构（马里兰大学医学中心，巴尔的摩，马里兰州）接受股动静脉ECMO拔管的患者。如果插管不是经皮进行的，或者经皮拔管未使用MANTA，则将患者排除。主要结局是下肢并发症。比较了股浅动脉（SFA）手动压迫与使用MYNX（科迪斯）或血管封堵器（泰尔茂医疗公司）经皮闭合远端灌注部位的情况。
共有160例患者接受了开放拔管，94例患者（30例在床边）接受了MANTA拔管。两组的ECMO支持中位持续时间均为六天。MANTA组和开放拔管组的术中修正率相似（9例[9.6%]对26例[16.4%]；P = 0.13）。MANTA组的4例修正为早期外科医生经验中的技术失败。在多变量模型中，与开放拔管相比，MANTA拔管的下肢并发症相对减少了46%（26.1%对39.6%；比值比，0.54；95%CI，0.28 - 1.00）。手动压迫与经皮闭合在SFA并发症方面无显著差异（14.4%对10.7%；比值比，0.71；95%CI，0.29 - 1.76）。
与股动静脉ECMO开放拔管相比，MANTA拔管的下肢并发症显著减少，从而实现了安全的床边拔管。经皮SFA闭合的结果与手动压迫相当。
