Total angio-guided percutaneous implantation and removal of veno-arterial extracorporeal membrane oxygenation using pre-closing technique, a retrospective monocentric experience

Abstract

The approach for veno-arterial extracorporeal membrane oxygenation implantation (VA-ECMO) can be either surgical or percutaneous. To describe the feasibility, safety, and efficiency of complete percutaneous cannulation and decannulation procedures using a pre-closing technique. All consecutive patients who underwent peripheral femoro-femoral VA-ECMO percutaneous implantation from March 2018 to April 2020 were enrolled. A percutaneous pre-closing technique using two closing devices (Perclose ProGlide) inserted before cannulation in both femoral artery and vein was used ( Fig. 1 ). This allowed a “TAVR like” percutaneous decannulation strategy with crossover technique under fluoroscopic guidance. The absence of bleeding or other vascular complication was assessed using femoral arteriography. We describe the patients’ and procedures characteristics and the outcomes. Thirty-five patients underwent percutaneous VA-ECMO implantation for cardiogenic shock or refractory cardiac arrest, 34/35 in the cath lab. Cannulation time was 22 ± 10 min. Weaning from ECMO was possible in 13 patients (37%). 30-day mortality was high (74%). Significant vascular complications occurred in 4 patients (11%). Two patients experienced major bleeding, and 2 experienced lower limb ischemia requiring vascular intervention (one failure of reperfusion implantation and one self-uprooting of the reperfusion canula). Percutaneous decannulation could be performed in 11 patients (31%) with a 100% technical success rate. All femoral arteries and veins were closed using the pre-closing devices without bleeding on the angiographic control. No groin infection occurred, no patient required transfusion and there was no need for surgical repair. Complete percutaneous angio-guided VA-ECMO implantation and decannulation using pre-closing technique is an effective and safe strategy in patients referred for refractory cardiogenic shock or cardiac arrest.