Abstract
Introduction: There remains a paucity of research regarding clinical characteristics and comparative outcomes of patients with tricuspid valve (TV) endocarditis, considered non-surgical candidates, undergoing debulking of TV vegetations using the AV(AngiVac) device compared to medical therapy. Methods: We conducted a retrospective cohort study at a single tertiary referral center comparing patients with TV endocarditis who were not considered surgical candidates. We compared clinical characteristics and outcomes in patients who underwent debulking of TV vegetations with AV vs those who were treated with medical therapy. Results: A total of 75 patients with TV endocarditis were included in the study. At baseline, patients in the medical therapy group were younger (34.4 years ± 10.5 vs 48.6 years ± 21, p < 0.0003), more frequently male in gender (55.9% vs 44%, p < 0.39) and had higher incidence of intravenous drug use (93.2% vs 56%, p < 0.0002). Patients were more likely to have history of malignancy (6% vs 1.7%, p < 0.32), cardiac implantable electronic device (31% vs 8.5%, p = 0.02) and central venous access (19% vs 1.7%, p = 0.01) if they underwent AV. Medical therapy was more commonly used for relatively smaller TV vegetations (1.68 cm vs 2.9 cm, p < 0.0001). Medical therapy was also associated with higher complication rates including distal embolization (81.4% vs 0%, p < 0.0001) and cerebrovascular accidents (5.1% vs 0% p = 0.36). In hospital mortality was similar for both groups and length of stay remained unchanged. Conclusions: Debulking of TV endocarditis with AV is feasible in patients not deemed to be surgical candidates and is not associated with higher inpatient mortality or length of stay. There was a lower rate of distal embolization and cerebrovascular accident in patients undergoing AV. Larger, multi center studies are needed to evaluate whether AV might improve outcomes in patients with TV endocarditis and large vegetations not deemed surgical candidates.
Published Version
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