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Percutaneous Mechanical Aspiration for Tricuspid Valve Infective Endocarditis: A Systematic Review and Meta-analysis.
Michel Pompeu Sá1, Christian Ken Fukunaga2, Eric Katsuyama2
1Department of Cardiovascular Surgery, Heart, Thoracic & Vascular Institute, Cleveland Clinic Florida, Weston, FL.
Journal of Cardiothoracic and Vascular Anesthesia
|March 12, 2026
Summary
Percutaneous mechanical aspiration (PMA) for tricuspid valve infective endocarditis (TVIE) and right-sided infective endocarditis (RSIE) shows feasibility and safety. PMA offers acceptable outcomes for high-risk patients, potentially serving as an alternative to surgery.
Area of Science:
- Cardiology
- Interventional Cardiology
- Infectious Diseases
Background:
- Tricuspid valve infective endocarditis (TVIE) and right-sided infective endocarditis (RSIE) pose significant clinical challenges.
- Surgical intervention for TVIE/RSIE carries substantial risks, particularly in high-risk patient populations.
Purpose of the Study:
- To evaluate the safety and effectiveness of percutaneous mechanical aspiration (PMA) in treating TVIE and RSIE.
- To assess mortality and complication rates associated with PMA in this patient cohort.
Main Methods:
- Systematic review and meta-analysis of retrospective studies.
- Searched PubMed, Embase, and Cochrane Central for studies on PMA in TVIE/RSIE.
- Analyzed data from 1,065 patients across eight studies, focusing on mortality, hospital stay, and complications.
Main Results:
- Pooled 30-day/in-hospital mortality was 5.7% (95% CI: 3.3-8.8%).
- Average hospital stay was 19.7 days (95% CI: 11.9-27.5).
- Complication rates included new pulmonary embolism (7.5%), IE recurrence (7.1%), and worsening tricuspid regurgitation (13.6%). Older age correlated with higher mortality, while intravenous drug use correlated with lower mortality.
Conclusions:
- Percutaneous mechanical aspiration (PMA) is a feasible and relatively safe option for TVIE/RSIE.
- PMA demonstrates acceptable mortality and complication rates in high-risk patients.
- Findings suggest PMA as a potential bridge to or alternative for surgical treatment, requiring prospective validation.
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