Outcomes and survival of patients undergoing percutaneous vegetectomy for right heart endocarditis

Abstract

BackgroundsAngioVacis used for the percutaneous removal of vegetations and fordebulking of large vegetations in patients who are not surgical candidates.This study aims to identify thedemographics, echocardiographic features, indications, improvement of the tricuspid valve regurgitation, and survival outcomes of patients who have undergone AngioVac vegetectomy reported in the literature. MethodsA systematic review was performed to identify articles reporting suction thromectomy or vegetation removal using the AngioVac system for RSIE (right sided infective endocarditis). Survival on discharge was our primary outcome. Additionally, we evaluated indications for suction thrombectomy and TR improvement.Categorical variables were expressed as percentages and ratios. ResultsA total of 49 studies were identified. The most common risk factor was intravenous drug abuse seen in 45% (20/49) and cardiovascular implantable electronic device (CIED) in 45% (20/49). Circulatory shock was seen in 35% of patients. The causative organism was gram positive cocci (86%).Moderate to severe TRwas present in 74% of cases with documented echocardiograms. Indications for AngioVacwerepoor surgical candidacy (81%) or to reduceseptic emboli risk(19%). Survival at dischargewas 93%.TR improvement was reported only in 16% cases and remained unchanged/worsened in 84%. ConclusionAngioVac procedure is an alternative treatment for critically ill patients who cannot undergo surgery. To understand the survival, safety and candidacy of patients undergoing this procedure, further randomized control studies and literature reviews are needed. The improvement or worsening of tricuspid regurgitation in patients with TR valve involvement is another factor to be investigated.