Percutaneous Mechanical Aspiration: A Game Changer for Infective Endocarditis?

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Infectious Diseases

Background:

• Rising incidence of right-sided infective endocarditis (RSIE) due to increased injection drug use, indwelling lines, and device implantation.
• Many RSIE patients are ineligible for surgery due to high risk, instability, or social factors, despite guideline recommendations for early referral.
• Percutaneous mechanical aspiration (PMA) is an emerging minimally invasive technique for debulking infected masses and managing RSIE.

Purpose of the Study:

• To evaluate the efficacy and safety of percutaneous mechanical aspiration (PMA) using the AngioVac system for treating infective endocarditis (IE).
• To compare PMA outcomes with traditional surgical interventions for RSIE.
• To explore the role of PMA as a bridge therapy for high-risk IE patients.

Main Methods:

• PMA utilizes a large-bore aspiration cannula connected to a veno-venous extracorporeal circuit.
• Continuous transesophageal echocardiography guides the procedure, with routine neuroprotection for left-sided targets.
• Data were analyzed from heterogeneous RSIE populations and selected left-sided infective endocarditis (LSIE) cases.

Main Results:

• Technical success rates for PMA approximate 85-90% across heterogeneous RSIE populations.
• Comparative analyses show broadly similar early and one-year mortality rates between PMA and tricuspid surgery.
• PMA is associated with a shorter length of stay and potentially lower costs compared to surgery.

Conclusions:

• PMA with the AngioVac system is a viable option for selected IE patients, particularly those with large tricuspid vegetations or device-related infections.
• It serves as an effective bridge to definitive therapy, expanding treatment options for inoperable patients.
• Further pragmatic, multicenter trials are needed to refine indications and integrate PMA into clinical guidelines.