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Catheter-Directed Aspiration for Right Atrial and Right Ventricular Masses: Trends in Use Over the Years and

Mukunthan Murthi1, Andres Quevedo-Ramirez1, Steve Attanasio2

  • 1John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois, USA.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|January 7, 2025
PubMed

Insights

Catheter-directed aspiration (CDA) for right heart masses is increasing. For pulmonary embolism (PE) with clot in transit (CIT), percutaneous catheter-directed thrombectomy (CDT) showed lower in-hospital mortality than surgery.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Vascular Surgery

Background:

  • Percutaneous mechanical aspiration thrombectomy is a minimally invasive option for right heart masses, including clot in transit (CIT).
  • Catheter-directed aspiration (CDA) is gaining traction for managing these conditions.

Purpose of the Study:

  • To analyze trends in the utilization of catheter-directed aspiration (CDA) for right heart masses.
  • To compare in-hospital outcomes between percutaneous and surgical approaches for patients with CIT and pulmonary embolism (PE).

Main Methods:

  • Retrospective cohort study using the National Inpatient Sample (NIS) database (2016-2020).
  • Included patients undergoing CDA for right heart mass/thrombus.
  • Identified PE patients with CIT undergoing percutaneous catheter-directed thrombectomy (CDT) or surgical embolectomy (SE).
  • Primary outcome: composite of in-hospital mortality, major bleeding, and stroke.

Main Results:

  • CDA use for right heart thrombus/mass increased significantly (203 in 2016 to 533 in 2020).
  • Among PE patients with CIT, 400 underwent CDT and 150 underwent SE.
  • No significant difference in composite endpoints between CDT and SE (31.2% vs. 40%, p=0.243).
  • CDT demonstrated significantly lower in-hospital mortality compared to SE (12.5% vs. 26.6%, p=0.015).

Conclusions:

  • Catheter-directed aspiration (CDA) use for right heart thrombus and mass is rising.
  • Percutaneous catheter-directed thrombectomy (CDT) offers a significantly lower in-hospital mortality rate for PE patients with clot in transit compared to surgical thrombectomy.
Abstract

Keywords:
percutaneous mechanical thrombectomypulmonary embolismsurgical pulmonary embolectomy

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