Abstract 15513: Angiovac as an Alternative to Surgical Excision of a Large Infective Endocarditis Vegetation

Abstract

Background: Angiovac device is a suction cannula inserted percutaneously or surgically connected to extracorporeal circuit approved for removal of fresh soft thrombi/emboli. Cardiac surgery is indicated in Infective Endocarditis (IE) when the vegetation is >10 mm. Angiovac is used for IE in nonsurgical candidates. Here, we present 2 cases of successful use of Angiovac in treating large IE vegetation. Presentation: (1) A 70-year-old male with HFrEF and inducible VF on electrophysiological study requiring ICD implantation admitted for sepsis with Corynebacterium stratum bacteremia. TTE revealed mobile echo-density, 24 X 14 mm attached to the RV ICD lead. (2) 67-year-old female with sinus node dysfunction requiring permanent pacemaker who presented with constitutional symptoms. Blood culture grew coagulase-negative Staphylococcus. TEE revealed echodense coating around the RV lead, 15 mm in thickness. Management: Patient 1 was deemed nonsurgical candidate by cardiothoracic surgery. Instead, Angiovac was performed. Intraoperative TEE revealed a 30x20mm right atrial ICD lead vegetation. Angiovac catheter was advanced under TEE guidance to the right atrium. Once the catheter was abutting the infected thrombus multiple aspiration harvesting embolic material as in the picture. A postprocedural TTE demonstrated the absence of the RA echodensity. A subsequent laser lead extraction was performed. Patient 2 was given IV vancomycin. Angiovac procedure was successfully performed with subsequent laser lead extraction planning. Conclusion: AngioVac is a minimally invasive and effective procedure in the management of large vegetations in nonsurgical candidate patients.