Full percutaneous decannulation of VA-ECMO using MANTA® and Femoseal® devices: a propensity-score based study

Background Percutaneous veno-arterial extracorporeal membrane oxygenation (VA-ECMO) implantation reduces infectious complications compared with surgical cannulation. However, arterial decannulation using manual compression remains associated with bleeding, vascular injury, and infection. We evaluated a fully percutaneous decannulation strategy (FP-D) combining MANTA® and Femoseal® devices. Methods All patients undergoing FP-D between October 2020 and May 2022 in our institution were included. Outcomes were compared with a historical cohort decannulated using manual compression (MC). The primary endpoint was surgical revision after decannulation. Secondary endpoints included major bleeding, transfusion, vascular complications, infection, and 30-day survival. A propensity score weighting approach was performed to adjust for baseline differences. Results Among 497 patients treated with percutaneous VA-ECMO, 250 underwent FP-D and 247 MC. After propensity score, FP-D significantly reduced surgical revision (3.9% vs 7.2%; RR 0.55, 95% CI 0.32–0.94; p = 0.0311), infection requiring surgery (3.7% vs 8.4%; RR 0.44, 95% CI 0.25–0.77; p = 0.004), and major bleeding (1.4% vs 11%; RR 0.13, 95% CI 0.06–0.30; p < 0.0001), with lower transfusion requirements (7.1% vs 45.7%; RR 0.16, 95% CI 0.11–0.22; p < 0.0001). Thirty-day survival was comparable between groups (91.8% vs 94.7%; p = 0.11). Systematic CT scans revealed frequent but mostly silent arterial lesions after FP-D. Conclusion FP-D markedly reduced bleeding, transfusion, infection, and surgical revision compared with manual compression, while preserving short-term survival. Systematic imaging identified frequent subclinical vascular lesions, supporting targeted surveillance and endovascular management when appropriate.