Percutaneous decannulation with a suture-mediated closure device versus open surgical repair for peripheral veno-arterial extracorporeal membrane oxygenation: A systematic review and meta-analysis.

OBJECTIVE: Peripheral veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) is commonly used to treat patients with severe cardiorespiratory dysfunction. Percutaneous decannulation (PD) using suture-mediated closure devices has emerged as an alternative to open surgical repair (OSR) following peripheral VA-ECMO. We performed a systematic review and meta-analysis to review and compare outcomes after VA-ECMO decannulation using PD versus OSR. METHODS: Six electronic databases were searched to 25 December 2025 for comparative studies evaluating PD versus OSR. Primary outcomes were access-related wound and vascular complications; secondary outcomes were inpatient mortality and procedure time. Outcomes were pooled as risk ratios (RRs) using random-effects models with the Hartung-Knapp adjustment, and are reported with 95% confidence intervals (CIs) and prediction intervals. RESULTS: Ten comparative studies comprising 829 patients (438 PD, 391 OSR) were included. PD was associated with fewer access-related wound complications than OSR (RR 0.26, 95% CI 0.12-0.56, I2=20.7%), although the 95% prediction interval (0.07-1.01) reached unity. Vascular complications did not differ significantly (RR 0.71, 95% CI 0.47-1.08, I2=0%), nor did inpatient mortality (RR 0.71, 95% CI 0.40-1.28, I2=40.9%). Procedure time was shorter with PD in all four studies reporting it, although the pooled estimate was heterogeneous and imprecise (mean difference -41.6 minutes, 95% CI -75.5 to -7.7, I2=95.0%). CONCLUSION: PD for VA-ECMO is associated with a lower incidence of access-related wound complications than OSR. Given the observational designs, clinical heterogeneity, and non-standardised outcome definitions of the available evidence, PD is best regarded as a reasonable option in carefully selected patients at centres with appropriate endovascular expertise, rather than as a default strategy.