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Published on: May 26, 2023
Percutaneous Multivalvular Endocarditis Debulking With a Whole-Body Embolic Protection Device
Ahmad Younes1, Carson Oostra2, Robert Roether3
1Jobst Vascular Institute, Promedica, Toledo, Ohio, USA.
Background:
Percutaneous debulking of left-sided endocarditis and thrombus has previously relied on cerebral-only embolic protection devices. The Emboliner is an investigational nitinol-mesh filter that provides whole-body embolic protection and has been studied in transcatheter aortic valve replacement.
Summary:
We describe its first reported use as an adjunct to AngioVac-based debulking in 2 patients: 1 with aortic valve endocarditis and 1 with combined tricuspid and mitral endocarditis.
Discussion:
The Emboliner was successfully deployed in both cases, with over 90% of vegetation removed and no periprocedural or in-hospital embolic events. Deployment technique differed by vegetation location: in the aortic valve case, the AngioVac cannula was advanced through the filter's access port; in the tricuspid/mitral case, no further interaction with the filter was required once deployed.
Novelty:
This represents, to our knowledge, the first reported use of whole-body embolic protection during aortic and combined tricuspid/mitral percutaneous endocarditis debulking.
Take-Home Message:
Whole-body embolic protection may offer an important adjunct to percutaneous debulking in patients at high surgical risk.
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