Efficacy and safety of the percutaneous suture-mediated vascular closure system for large-bore mechanical circulatory support access site closure

Background Mechanical circulatory support (MCS), such as venoarterial extracorporeal membrane oxygenation (VA-ECMO) or a catheter-based heart pump (Impella), is crucial for rescuing patients with severe cardiogenic shock. However, these MCS devices require large-bore cannula access via the femoral artery (14-Fr to 18-Fr) or vein (24-Fr), often necessitating surgical decannulation. Recently, percutaneous suture-mediated vascular closure systems (SMC), the Perclose ProGlide/ProStyle, have proven useful in stent grafting and structural heart disease applications. Objective This single-center retrospective cohort study evaluated the safety and efficacy of MCS decannulation using the SMC system. Methods Between January 2018 and December 2024, 295 patients who received Impella (n=213) and/or VA-ECMO (n=218) were included in the study. Among these, 146 Impella access sites and 118 VA-ECMO access sites were successfully weaned off. After excluding cases of transfer to another institution, Impella 5.5 insertion via the axillary artery, escalation from Impella 2.5/CP to Impella 5.0/5.5, immediate explantation in the operating room following cardiac surgery, and cases where hemostasis was achieved by manual compression, a total of 112 Impella access sites and 103 VA-ECMO access sites were evaluated. Access sites were divided into two groups for decannulation: the SMC removal group (n=88) and the surgical removal group (n=34) for Impella, and the SMC removal group (n=62) and the surgical removal group (n=41) for VA-ECMO. For both Impella and VA-ECMO removal, we compared the procedure time, the number of SMC devices used, and procedure-related complications—including vascular injury requiring endovascular treatment, major bleeding requiring massive transfusion, and access site infections—between the SMC and surgical groups. Results For Impella removal, all access sites were successfully decannulated using the SMC system. The average number of SMC devices used was 1.55 ± 0.84. Procedure time was significantly shorter in the SMC group compared to the surgical group (14 [10–22] min vs. 50 [39–74] min; p<0.001). There was no significant difference in the rate of procedure-related complications between the two groups (8% vs. 12%; p=0.523). For VA-ECMO removal, 98% of access sites were successfully decannulated using the SMC system, with only one case requiring conversion to surgical removal. The average number of SMC devices used for arterial access was 1.88 ± 1.26. For venous access, an average of 0.19 ± 0.51 SMC devices were used, and adjunctive Z-suture placement was performed in 97% of patients. Procedure time was significantly shorter in the SMC group (20 [15–26] min vs. 65 [46–87] min; p<0.001). There was no significant difference in procedure-related complications between the two groups (13% vs. 15%; p=0.803). Conclusion Our findings suggest that post-closure with an SMC system is a safe and effective method for large-bore MCS decannulation.