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Published on: October 28, 2020
Transcatheter Aspiration of Tricuspid Vegetation
Akiva Brin1, Danny Dvir1, Emanuel Harari2
1Jesselson Integrated Heart Center, The Eisenberg R&D Authority, Shaare Zedek Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel.
Objective:
This study sought to present the endovascular approach of transcatheter aspiration using the FlowTriever (Inari Medical) aspiration system for high surgical risk patients with right-sided infective endocarditis.
Key Steps:
General anesthesia and transesophageal echocardiogram guidance; ultrasonography-guided femoral vein access, preclosure sutures, and insertion of a 24-F sheath; insertion of straight 24-F aspiration cannula over a stiff wire, parked in the superior vena cava; introduction of a 20-F curved cannula inside the 24-F cannula to create a telescopic assembly; accurate positioning using the right ventricle inflow/outflow projection in biplane mode; adjustment of the curved cannula radius by sliding the inner cannula in and out inside the mother cannula; manual aspiration of the vegetation; Postaspiration transesophageal echocardiogram assessment.
Potential Pitfalls:
Avoid leaflet and annular injury and account for potential embolization.
Take-Home Messages:
Endovascular aspiration using the aspiration system is an advanced therapeutic approach for high-risk patients with right-sided IE. The aggregative knowledge about transcatheter aspiration of tricuspid vegetation suggests a safe and effective procedural profile.
