Mid-Term Outcomes of Percutaneous Decannulation for Venoarterial Extracorporeal Membrane Oxygenation Weaning: A Single-Centre Experience

Objective Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is an established therapy for severe cardiac failure, but femoral decannulation remains associated with significant morbidity. Percutaneous decannulation has emerged as an alternative to surgical cutdown; however, published experience remains limited. This study evaluates a fully percutaneous VA-ECMO decannulation strategy using the Abbott ProStyle vascular closure device compared with open surgical cutdown. Methods A retrospective single-centre matched cohort study identified all patients undergoing intended percutaneous VA-ECMO decannulation between November 2023 and January 2026 and matched them to a surgical cutdown cohort according to age and sex. Outcomes were assessed by intention-to-treat, with technically successful cases evaluated secondarily. Results Twenty-eight patients underwent intended percutaneous VA-ECMO decannulation. Technical success was achieved in 82% (n = 23), with five conversions to open cutdown. On intention-to-treat analysis, procedural duration was shorter (94.1 ± 26.3 vs 121.7 ± 46.9 minutes, p = .063) and groin wound complications were less frequent (7.1% vs 25.0%, p = .077), although neither reached statistical significance. Among technically successful percutaneous decannulations, procedural duration was significantly shorter (88.0 ± 28.7 vs 120.8 ± 50.0 minutes, p = .020) and groin wound complications significantly lower (4.3% vs 30.4%, p = .047). Survival to discharge was similar between groups (p = .78). Conclusion Percutaneous VA-ECMO decannulation achieved 82% technical success, with numerically shorter procedural duration and fewer groin wound complications on intention-to-treat analysis. Among technically successful cases, both outcomes were significantly improved compared with surgical cutdown.