Meta-analysis: percutaneous versus surgical VA-ECMO decannulation demonstrates no clear differences in most outcomes, with a signal toward lower infection.

Venoarterial Extracorporeal Membrane Oxygenation (ECMO) is a life-support therapy for critical cardiac or respiratory failure, and decannulation requires arterial access closure. The traditional surgical repair is effective but carries risks inherent to invasive procedures. Percutaneous vascular access closure has been developed as a less invasive alternative, though direct comparative evidence has been limited. We performed a systematic review and meta-analysis of 10 studies published between 2011 and 2024, encompassing 1074 patients and comparing surgical closure versus percutaneous closure. Outcomes assessed included limb infection, ischemia, pseudoaneurysm, bleeding events, ECMO duration, and in-hospital mortality. Results demonstrated no statistically significant differences across most outcomes, including limb ischemia (OR = 0.79; 95% CI 0.44-1.40; p = 0.415), pseudoaneurysm (OR = 0.88; 95% CI 0.45-1.72; p = 0.704), bleeding events (OR = 0.48; 95% CI 0.08-2.82; p = 0.316), ECMO duration (Mean Difference = - 25.4711; 95% CI = - 63.7896-12.8474; p = 0.1639) and mortality (OR = 0.74; 95% CI 0.50-1.10; p = 0.134). In contrast, the pooled OR indicated a significant 94.1% decrease in odds of infection associated with percutaneous closure (OR = 0.06; 95% CI = 0.02-0.17; p = 0.002). No heterogeneity was identified (I