Meta-analysis: percutaneous versus surgical VA-ECMO decannulation demonstrates no clear differences in most outcomes, with a signal toward lower infection.

Abstract

Venoarterial Extracorporeal Membrane Oxygenation (ECMO) is a life-support therapy for critical cardiac or respiratory failure, and decannulation requires arterial access closure. The traditional surgical repair is effective but carries risks inherent to invasive procedures. Percutaneous vascular access closure has been developed as a less invasive alternative, though direct comparative evidence has been limited. We performed a systematic review and meta-analysis of 10 studies published between 2011 and 2024, encompassing 1074 patients and comparing surgical closure versus percutaneous closure. Outcomes assessed included limb infection, ischemia, pseudoaneurysm, bleeding events, ECMO duration, and in-hospital mortality. Results demonstrated no statistically significant differences across most outcomes, including limb ischemia (OR = 0.79; 95% CI 0.44-1.40; p = 0.415), pseudoaneurysm (OR = 0.88; 95% CI 0.45-1.72; p = 0.704), bleeding events (OR = 0.48; 95% CI 0.08-2.82; p = 0.316), ECMO duration (Mean Difference = - 25.4711; 95% CI = - 63.7896-12.8474; p = 0.1639) and mortality (OR = 0.74; 95% CI 0.50-1.10; p = 0.134). In contrast, the pooled OR indicated a significant 94.1% decrease in odds of infection associated with percutaneous closure (OR = 0.06; 95% CI = 0.02-0.17; p = 0.002). No heterogeneity was identified (I² = 0%), and meta-regression results were non-significant, suggesting that the device type did not serve as a modifier (p = 0.23).Overall, this analysis reflects the current state of the literature and does not demonstrate consistent differences between percutaneous and surgical approaches across most outcomes. While percutaneous closure may be associated with lower odds of infection, this finding should be interpreted cautiously given the limited number and observational nature of the included studies. However, these results highlight that infection may be an important outcome to prioritize in future investigations. Larger, prospective investigations are needed to better define the comparative effectiveness and safety of these approaches.