A Novel Approach in the Management of right-sided Endocarditis: Percutaneous Vegectomy Using the AngioVac Cannula

Abstract

The AngioVac is a vacuum-based device introduced in 2012 to percutaneously remove undesirable material from the intravascular system. In scattered reports, the AngioVac has been used for removal of device-led vegetations and right-sided thrombi. In this article, we describe three cases of right-sided endocarditis treated with AngioVac: a mobile mass extending from the vena cava into the right atrium, large native tricuspid vegetations, and bioprosthetic tricuspid vegetations. This device shows benefit in reducing vegetation load, decreasing septic lung embolization, and reducing reinfection in active intravenous drug users. These cases exhibit the AngioVac's arrival as a new and exciting tool in endocarditis treatment, providing an alternative to open surgery and accessorizing antimicrobial treatment.

Repeat Infective Endocarditis in Persons Who Inject Drugs: “Take Another Little Piece of my Heart”*

“…Duration of bacteremia, type and results of echocardiography, and complications of infection including need for intensive care admission were assessed. Invasive management interventions including surgical procedures (valve repair, replacement, or annuloplasty) and removal of vegetations using a percutaneous vegectomy device [13] were documented. For repeat IE admissions, an episode caused by a microorganism of the same species (same organism and no more than 1 discrepancy on susceptibility testing) within 6 months of the initial episode was classified as relapse, whereas all other episodes were classified as reinfections [14].…”

Feasibility of concomitant vacuum‐assisted removal of lead‐related vegetations and cardiac implantable electronic device extraction

“…Current masses (vegetation or thrombus >2.5 cm). [10][11][12][13][14][15][16][17] The purpose of this retrospective study is to report upon the outcome of a series of patients who underwent percutaneous vacuum-assisted removal of large CIED-related vegetations followed by complete device and lead removal during the same procedure. [7][8][9] Recently, several case reports described vacuum-assisted right-sided thrombi or lead vegetation removal, followed by percutaneous device and lead removal.…”

“…[7][8][9] Recently, several case reports described vacuum-assisted right-sided thrombi or lead vegetation removal, followed by percutaneous device and lead removal. [10][11][12][13][14][15][16][17] The purpose of this retrospective study is to report upon the outcome of a series of patients who underwent percutaneous vacuum-assisted removal of large CIED-related vegetations followed by complete device and lead removal during the same procedure.…”

The AngioVac system as a bail-out option in infective valve endocarditis

“…In recent years, several case reports and case series have introduced a novel, minimally-invasive technique using a percutaneous aspiration system to debulk tricuspid valve vegetations in patients with a high operative risk. This concept of debulking tricuspid valve vegetations aims to reduce bacterial load in order to allow antimicrobial therapy to cure the infection or to stabilize the patient as a bridge to surgery (4)(5)(6)(7)(8).…”