The Effect Of Closure Devices On Complications Following Percutaneous Circulatory Support Device Removal
Daniel B. Kim, Zach M. Feldman, MD, Hannah Miksenas, Junaid Y. Malek, MD, Mark F. Conrad, MD, Samuel I. Schwartz, MD.
Massachusetts General Hospital, BOSTON, MA, USA.
OBJECTIVES: Several temporary mechanical circulatory support devices have developed into therapeutic options in the management of patients with acute cardiogenic shock. Three of the most common devices placed in a percutaneous manner include intraaortic balloon pumps (IABP), percutaneous ventricular assist devices (PVAD), and extracorporal membrane oxygenation (ECMO). This study evaluates the association of closure device usage on the complication rates of these percutaneous support devices once they are removed.
METHODS: We performed a retrospective review of all patients from 2016-2018 who had undergone percutaneous placement and removal of a circulatory support device at a tertiary referral hospital. Patients were stratified by means of removal (manual pressure vs percutaneous closure device). Chi-squared tests for univariate comparisons of categorical values were performed.
RESULTS: Overall, 331 patients had percutaneous circulatory support devices used during the study period; 57 patients had closure devices utilized (17.2%). The proportion of IABP and PVAD arteriotomies within a 6 - 10 Fr range were 85.3% and 89.3% respectively. Percutaneous ECMO cannulations were all greater than 11 Fr. The table below shows local and systemic complication rates as well as 30-day mortality for each type of percutaneous circulatory device.
CONCLUSIONS: Mechanical circulatory support devices are often placed in urgent or emergent fashion; placement of closure devices may not always be feasible. In more elective situations, closure devices may be beneficial given the high complication rates with manual pressure alone.
| N | Local Complication | p-value | Systemic complication | p-value | 30 day mortality | p-value | |
| Intra-aortic balloon pump | 214 | ||||||
| Manual pressure | 196 | 5.1% | <0.01 | 6.6% | <0.01 | 10.7% | .074 |
| Percutaneous closure device | 18 | 0.0% | 0.0% | 5.6% | |||
| Percutaneous ventricular assist device | 71 | ||||||
| Manual pressure | 33 | 18.2% | <0.01 | 3.0% | <0.01 | 21.2% | <0.01 |
| Percutaneous closure device | 38 | 5.3% | 5.3% | 7.9% | |||
| Percutaneous ECMO | 46 | ||||||
| Manual pressure | 45 | 15.2% | <0.01 | 4.3% | <0.01 | 32.6% | 0.01 |
| Percutaneous closure device | 1 | 0.0% | 0.0% | 0.0% |
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