Comparison of Percutaneous Closure Versus Surgical Femoral Cutdown for Decannulation of Large-Sized Arterial and Venous Access Sites in Adults After Successful Weaning of Veno-Arterial Extracorporeal Membrane Oxygenation

作者：Majunke Nicolas^*; Mangner Norman; Linke Axel; Boudriot Enno; Erbs Sandra; Tietz Franziska; Wolff Sabrina; Schuerer Stephan; Schuler Gerhard; Sandri Marcus

来源：Journal of Invasive Cardiology, 2016, 28(10): 415-419.

• cardiogenic shock
• veno-arterial extracorporeal membrane oxygenation
• VA-ECMO

Objective. Surgical femoral cutdown for decannulation after veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is considered standard practice. However, access-site complications with this technique are not rare. The objective of this study is to evaluate feasibility, safety, and efficacy of a complete percutaneous decannulation procedure after VA-ECMO compared with the conventional surgical cutdown approach. Methods. In 35 patients who were successfully weaned from VA-ECMO support, femoral artery and vein access sites were closed using a completely percutaneous approach in 15 patients, whereas 20 patients had conventional surgical cutdown for access-site closure. Data concerning all 35 patients were collected retrospectively and analyzed regarding immediate vascular closure success, associated complications, and clinical outcomes. Results. Technical deployment success of the percutaneous vascular closure devices was achieved in all patients. Immediate success of closure was achieved more frequently in the surgical group (29% vs 100%; P<.05). Severe wound complications requiring surgery occurred only in the surgical group (0% vs 35%; P=NS). Surgical cutdown was associated with a significantly greater need for transfusion of packed red blood cells (1.6 +/- 1.4 vs 2.2 +/- 1.2; P<.05). Mean hospital stay was shorter in the percutaneous group (32 +/- 18 days vs 36 +/- 12 days; P=NS). One patient in the surgical group complained about sustained paresthesia after discharge. Conclusions. Complete percutaneous closure of the femoral access site after VA-ECMO is feasible, effective, and safe when compared with conventional surgical closure and performed by experienced operators.

• 出版日期2016-10