A case of percutaneous tricuspid valve infective endocarditis vegetation debulking using the AngioJet rheolytic catheter system-A novel therapeutic use

Transcatheter vacuum aspiration of valvular and lead related infective endocarditis

BACKGROUND

Transcatheter aspiration is utilized for removal of thrombi and vegetations in inoperable patients and high-risk surgical candidates where medical therapy alone is unlikely to achieve desired outcome. A number of case reports and series have been published since the introduction of AngioVac system (AngioDynamics Inc., Latham, NY) in 2012 where this technology was used in the treatment of endocarditis. However, there is a lack of consolidated data reporting on patient selection, safety and outcomes.

METHODS

PubMed and Google Scholar databases were queried for publications reporting cases where transcatheter aspiration was used for endocarditis vegetation debulking or removal. Data on patient characteristics, outcomes and complications from select reports were extracted and systematically reviewed.

RESULTS

Data from 11 publications with 232 patients were included in the final analyses. Of these, 124 had lead vegetation aspiration, 105 had valvular vegetation aspiration, and 3 had both lead as well as valvular vegetation aspiration. Among the 105 valvular endocarditis cases, 102 (97 %) patients had right sided vegetation removal. Patients with valvular endocarditis were younger (mean age 35 years) vs. patients with lead vegetations (mean age 66 years). Among the valvular endocarditis cases, there was a 50-85 % reduction in vegetation size, 14 % had worsening valvular regurgitation, 8 % had persistent bacteremia and 37 % required blood transfusion. Surgical valve repair or replacement was subsequently performed in 3 % and in-hospital mortality was 11 %. Among patients with lead infection, procedural success rate was reported at 86 %, 2 % had vascular complications and in-hospital mortality was 6 %. Persistent bacteremia, renal failure requiring hemodialysis, and clinically significant pulmonary embolism occurred in about 1 % each.

CONCLUSIONS

Transcatheter aspiration of vegetations in infective endocarditis has acceptable success rates in vegetation debulking as well as rates of morbidity or mortality. Large prospective multi-center studies are warranted to determine predictors of complications, thus helping identify suitable patients.

Catheter-Directed Vegetation Aspiration in Tricuspid Valve Bacterial Endocarditis: A Potential Treatment for Poor Surgical Candidates

Infective endocarditis is a condition that has the potential to cause significant morbidity and mortality. Potential complications include sepsis, heart failure, atrioventricular block, embolic stroke, septic emboli, and intracardiac abscess formation. The backbone of treatment is intravenous antibiotics; however, in certain clinical scenarios, surgical management is also indicated to reduce complications and mortality. There exists a challenging subset of patients who require surgery but carry a high perioperative mortality risk. Percutaneous management of endocarditis is emerging as a potential treatment for this high-risk group of patients: it allows for an attempt at source control while avoiding the high risks of surgery. Herein, we present the case of a 35-year-old male presenting with hemoptysis secondary to pulmonary septic emboli in the setting of Enterococcus faecalis tricuspid endocarditis. He was determined to be a poor surgical candidate and underwent catheter-directed debulking of the tricuspid vegetation with excellent results.