Percutaneous Mechanical Aspiration for Tricuspid Valve Infective Endocarditis: A Systematic Review and Meta-analysis

To assess the safety and effectiveness of percutaneous mechanical aspiration (PMA) for tricuspid valve infective endocarditis (TVIE) and right-sided infective endocarditis (RSIE).

Systematic review and meta-analysis.

Tertiary care.

Patients with confirmed TVIE and/or RSIE.

PMA.

A systematic review and meta-analysis were conducted according to the PRISMA and MOOSE guidelines (PROSPERO registration: CRD420251173875). PubMed, Embase, and Cochrane Central were searched from inception to September 2025 for studies reporting outcomes of PMA in TVIE and/or RSIE. The primary endpoint was 30-day and/or in-hospital mortality. Secondary outcomes included hospital length of stay, new pulmonary embolism, recurrence of TVIE and/or RSIE, and worsening tricuspid regurgitation. Pooled estimates were calculated using random-effects models, and meta-regression was conducted to explore the influence of age, intravenous drug use, and sex on mortality. Eight retrospective studies comprising 1,065 patients were included. The pooled 30-dayand/or in-hospital mortality rate was 5.7% (95% confidence interval [CI]: 3.3-8.8%, I² = 56%). Mean hospital stay was 19.7 days (95% CI: 11.9-27.5, I² = 98%). New pulmonary embolism occurred in 7.5% (95% CI: 4.9-10.5%), recurrence of IE in 7.1% (95% CI: 0.3-21.8%), and worsening tricuspid regurgitation in 13.6% (95% CI: 10.3-17.2%). Meta-regression identified that older age correlated with higher mortality (p = 0.031), and higher intravenous drug use prevalence correlated with lower mortality (p = 0.017).

PMA for TVIE and/or RSIE appears feasible and relatively safe, offering acceptable mortality and complication rates in high-risk patients. These findings support PMA as a potential bridge or alternative to surgery, warranting prospective validation in controlled trials.