MVCD may be a minimally invasive option for complex VA-ECMO decannulation procedures.A systematic review and meta-analysis suggest that the MANTA® vascular closure device (MVCD) is a promising, effective, and reliable approach for achieving haemostasis after percutaneous veno-arterial extracorporeal membrane oxygenation (VA-ECMO) decannulation.
“This [analysis provides] important insights into the effectiveness [of MVCD] in managing large-bore vascular access. It presents evidence that this method is associated with a high technical success rate and a low incidence of decannulation-related complications,” the investigators said.
In the final analysis of seven observational studies (n=235; average age 56.6 years, 73.61 percent men), the overall efficacy of MVCD in VA-ECMO decannulation was 94.8 percent (standard error 1.6 percent; p<0.001). [J Vasc Access 2026;27:39-51]
This technical success rate was achieved despite additional challenges that may arise after VA-ECMO, such as ECMO-associated coagulopathy, which can complicate haemostasis. [Semin Thromb Hemost 2020;46:62-72]
The incidence of arterial thrombosis was 7.1 percent; acute limb ischaemia, 5 percent; major arterial bleeding, 4.1 percent; emergency open repair after MVCD failure, 3.7 percent; and pseudoaneurysms, 3.2 percent.
There were no procedure-related deaths, underscoring the strong safety profile of this technique, the researchers noted.
Advantages over surgical decannulation
“The increasing adoption of ECMO as a cardiopulmonary support system has been driven by its relatively straightforward implementation, the growing presence of mobile ECMO teams, and the widening scope of clinical indications,” the researchers said.
Surgical decannulation is the standard practice, but it comes with significant risks, including high rates of periprocedural complications, such as bleeding, ischaemia, compartment syndrome, amputations, and infections, as well as high patient mobilization costs. [Ann Thorac Surg 2014;97:610-616]
Percutaneous techniques, such as MVCD, have significantly reduced these risks by eliminating the need for open surgery and enabling faster and safer decannulation. [Intensive Care Med 2018;44:2153-2161; J Vasc Access 2025;26:1651-1660]
VA-ECMO decannulation with MVCD avoids the need for transport to the operating room, for general anaesthesia, and for an incision to the groin—an area prone to infection, poor healing, and lymphatic leakage. [J Vasc Surg 2018;67:542-548] A study shows that decannulation with MVCD led to significantly lower rates of haematomas, seromas, and surgical site infections requiring intervention compared with surgical decannulation. [Scand J Surg 2023;112:256-264]
MVCD also enables clinicians to achieve rapid haemostasis while preserving vessel integrity following the removal of large-bore arterial cannulas used in peripheral VA-ECMO. [JACC Cardiovasc Interv 2016;9:1195-1196]
“MVCD is the first VCD designed explicitly for large-bore arteriotomy closure, featuring a poly(lactic-co-glycolic acid) intra-arterial toggle and an extravascular bovine collagen plug,” the researchers explained.
Overall, this review and meta-analysis underscore the safety and efficacy of MVCD in achieving haemostasis following VA-ECMO decannulation, with an acceptable success rate and low incidence of major complications, they said. “[The analysis] adds to the growing body of evidence supporting MVCD as a minimally invasive option for complex VA-ECMO decannulation procedures.”
The investigators called for larger, multicentre studies with uniform follow-up to ascertain the findings and precisely evaluate complication rates.