Published online Oct 26, 2024. doi: 10.4330/wjc.v16.i10.574
Revised: August 12, 2024
Accepted: September 11, 2024
Published online: October 26, 2024
Processing time: 175 Days and 10.4 Hours
The MANTA vascular closure device (VCD) represents a novel approach to achieving hemostasis after large-bore femoral access procedures. Numerous clinical studies have evaluated the efficacy of the MANTA device across a range of patient populations undergoing different procedures. However, there is still a paucity of data available concerning the use of MANTA devices in aiding the decannulation of venoarterial extracorporeal membrane oxygenation (VA-ECMO).
To present our single-center experience of utilizing the MANTA VCD in patients undergoing this procedure.
This single-center study included all patients undergoing percutaneous decannulation of femoral VA-ECMO using the MANTA plug-based VCD between January 2021 and October 2023 at University Hospitals Cleveland Medical Center. Inclusion criteria were adult patients who required prolonged (> 24 hours) hemodynamic support with VA-ECMO. Outcomes included all-cause mortality, hemostasis, bleeding, limb ischemia, and site infection.
This is a retrospective cohort study of 19 patients with a mean age of 56.8 years. Twelve of them were males with a mean body mass index of 29. The most common extracorporeal membrane oxygenation indication was acute coronary syndrome complicated by cardiogenic shock at 36.8%. The mean length of intensive care unit stay for these patients was 18.8 ± 8.42 days. Seventeen out of 19 patients survived to discharge. The MANTA device was successfully deployed in 19 patients, with 10 procedures conducted at the bedside and 9 in an operating room setting. Complete hemostasis was achieved within 5 minutes of MANTA deployment in 17 out of 19 patients. In 2 patients manual compression after Manta deployment was required to achieve adequate hemostasis. Additionally, acute lower extremity ischemia was noted in two patients, necessitating endovascular interventions. No infections were reported at the site of MANTA deployment.
Overall, based on our experience and that of other centers, the MANTA VCD has proven to be a simple, safe, and effective percutaneous technique for facilitating in the OR, but most of all it opens the opportunity for bedside VA-ECMO decannulation. Post-decannulation ischemic complications are higher in this series of sick patients when compared with elective procedures like transcatheter aortic valve replacement and endovascular aneurysm repair. Additionally, operators should be mindful of the incidence of ischemic complications. Distal Doppler pulse signals should always be checked, to indicate bailout options when this occurs.
Core Tip: The MANTA vascular closure device offers a novel approach to achieving hemostasis after large-bore femoral access procedures, particularly in complex interventions like transcatheter aortic valve replacement and endovascular aneurysm repair. This single-center study assessed the use of MANTA for percutaneous decannulation in 19 patients undergoing venoarterial extracorporeal membrane oxygenation. The device achieved rapid hemostasis in most cases, though some patients experienced late bleeding or ischemic complications. Despite these challenges, MANTA allowed for bedside decannulation, reducing the need for operating room resources. While promising, the study's small size and lack of a comparison group suggest that further research is needed to validate these findings.