Percutaneous Thrombo-Vegectomy as an Alternative to Surgery for Tricuspid Valve Endocarditis

BACKGROUND Urgent valve surgery to treat patients with tricuspid valve endocarditis carries a high risk of operative morbidity and mortality. Use of a percutaneous vacuum-assisted system to treat tricuspid valve endocarditis is an alternative to surgery. METHODS We retrospectively analyzed data from 187 transcatheter vacuum-assisted aspiration procedures performed in 177 patients with tricuspid valve vegetations at 3 different centers between 2017 and April 2022. The device was deployed via the internal jugular or femoral vein into the right atrium using transesophageal echocardiography and fluoroscopy guidance with the return cannula placed in the femoral vein. Intravascular material aspirated, collected in an external filter and cultured, length of stay, procedural complications, blood culture clearance and tricuspid regurgitation were analyzed. RESULTS Mean age was 35.5±10.8 years (range 18-79). One hundred seven procedures (57.2%) were performed for females and 163 (87.2%) for intravenous drug users. All patients survived the procedure and there were no procedural complications. Average length of stay was 26.8±18.5 days (range 1-96). The majority of pre-op positive blood cultures were S. aureus (80.3%) with post-operative cultures converting to negative in 103 (70.1%) of 147 procedures. Tricuspid regurgitation remained unchanged following 95 (50.8%) procedures and worsened following 40 (21.4%) procedures. CONCLUSIONS Percutaneous vacuum-assisted aspiration system provides a safe alternative to urgent tricuspid valve surgery for removal of vegetations, especially in endocarditis patients. Initial vegetation debulking can expedite clearance of blood cultures while avoiding major cardiac surgery and implantation of prosthetic valves in this high-risk patient population.