Abstract 13750: Concomitant Transcatheter Debulking of Right Heart Vegetations During Extraction of Transvenous Device System for Endocarditis: An Eight Case Series

Abstract

Background: Right heart (RH) infective endocarditis (IE) is a rare but serious complication of transvenous devices (TVD) often requiring system extraction. Surgery is often necessary for large vegetations or when bacteremia persists despite antibiotics. Objective: To evaluate outcomes of patients who underwent transcatheter debulking of IE-related RH vegetations in the setting of a transvenous device endocarditis. Methods: Patients with TVD and IE with RH vegetations were included in this analysis. Half of the patients were debulked using a thrombus aspiration system, while in the other half a hydrodynamic thrombectomy system was used. This was completed via a femoral approach with intracardiac echocardiography guidance. Intra and post-procedural outcomes were recorded. Results: Eight patients with a median age of 58 years, 62.5% male, with TVD, IE, and RH vegetations were included. Vegetations were located on the TV (2), RA lead (4), RV lead (2) and the floor of the RA along the cavotricuspid isthmus (1). The largest vegetation in this series was 5 cm by 2 cm with a volume of 62.83 cm3 and the smallest was 0.4 cm by 0.3 cm with a volume of 0.15 cm3. All patients had substantial vegetation burden causing clinically significant valve dysfunction. The vegetations were successfully debulked in all eight cases. Post-procedure imaging in all eight patients showed at least a 80% reduction in vegetation burden. All patients with TVP leads underwent successful extraction of the pacing systems. All patients tolerated their procedures well and remained free of infection at follow-up after completing a 6-week course of intravenous antibiotics. There were no procedure-related adverse events recorded within 30 days of intervention. Conclusion: TCD is a potential alternative in patients with device infection and large vegetations who are not candidates for surgical intervention. Long-term implications of this intervention in this high-risk population needs further studies.