Full percutaneous angio-guided ECLS implantation reduces major vascular complications as compared to surgical implantation

Abstract

Abstract Background Veno-arterial extracardiac life support (VA-ECLS) has become the current practice for managing severe refractory cardiogenic shock and cardiac arrest. Both surgical and percutaneous approaches can be used for VA-ECLS implantation, with the latter seeming to be associated with fewer complications. A full percutaneous approach using pre-closing enables percutaneous implantation but also explantation and may further decrease vascular complication. We aimed to address the incidence of vascular complications and 30-day mortality using full percutaneous ECLS implantation as compared to surgical implantation. Methods We included all patients who received VA-ECLS in a single center between January 2017 and December 2022. All patients had VA-ECLS implantation for severe cardiogenic shock or cardiac arrest, and post-operative patients were excluded. We compared 30-day survival and major vascular complications incidence (major bleeding, groin infection, limb ischemia) between the percutaneous and surgical groups. Results A total of 221 patients (mean of 53 years old, 71% men) received VA-ECLS, 115 using full percutaneous approach and 106 using surgical approach. ECLS was implanted in the setting of eCPR in 83 patients (37.7%). Baseline characteristics and clinical severity were comparable between the two groups. In the angio-guided group, there were significantly fewer major bleeding events (7% versus 27%, p<0.01) and groin infection (3.5% versus 12%, p=0.018) compared with the surgical group, but no difference in the incidence of limb ischemia (8.8% versus 10.1%, p=0.74) was observed. Thirty day mortality tended to be lower in the percutaneous group (69.6%) than in the surgical group (79.2%), but this difference did not reach statistical significance (p=0.076). Predictive factors of mortality at 30 days were BMI, SOFA score at implantation, age, and refractory arrest. Conclusion Full percutaneous ECLS implantation dramatically reduces major vascular complications as compared to surgical implantation. Larger studies are needed to determine if this benefit may increase survival.