A novel approach to percutaneous removal of large tricuspid valve vegetations using suction filtration and veno‐venous bypass: A single center experience

George, Bennet; Voelkel, A; Kotter, John; Leventhal, Andrew; Gurley, John C.

doi:10.1002/ccd.27097

Cited by 62 publications

(56 citation statements)

References 24 publications

(37 reference statements)

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“…operative mortality in 33 patients. 6 A recently published editorial referenced a case series of 78 patients treated with Angiovac; however, the authors did not report their survival statistics. 21 Our data combined with that from George et al 6 Using this definition we found an impressive 86% success rate.…”

Section: Preoperative Characteristicsmentioning

confidence: 99%

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Vacuum‐assisted extraction of ilio‐caval and right heart masses: A 5‐year single center experience

Newman¹,

Patel

Keeling

et al. 2020

J Card Surg

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Purpose Despite paucity of data, there exists growing popularity of catheter‐based extraction methods for intravascular thrombi and vegetations. We describe a large single center experience with vacuum‐assisted extraction techniques (VAET) for right‐sided intravascular and cardiac masses. Methods We retrospectively reviewed the perioperative course of patients undergoing VAET between 2014 and 2019. Primary outcomes were survival and freedom from recurrent bacteremia. Procedural success was a composite definition of survival, majority of mass extraction, absence of recurrent bacteremia, and valve function not requiring further intervention during index hospitalization. Results Of the entire cohort (n = 58), 48% and 52% underwent VAET for vegetations and sterile thrombi, respectively. Of those with positive cultures, the most common organism isolated was Staphylococcus aureus (48%). Preoperative active bacteremia was present in 36% (21/58) and of these patients, 76% (16/21) had neither recurrent nor persistent bacteremia post‐op. The majority of masses (67%, 38/58) were debulked with an average reduction in size of 42%. Conversion to open surgery occurred in 3.5% (2/58). Intraoperative and 30‐day survival were 98% (57/58) and 90% (28/31), respectively. Overall success was 86% (50/58). The prevalence of moderate/severe tricuspid regurgitation was 37% pre‐op and 61% post‐op. Average length of intensive care unit and overall hospital stay was 5.6 and 16 days, respectively. Conclusions In this single center experience, VAET was conducted safely with a high degree of success and freedom from short‐term recurrent bacteremia. This minimally invasive procedure is an attractive alternative to traditional open techniques for removal of right‐sided intravascular and cardiac masses.

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Section: Preoperative Characteristicsmentioning

confidence: 99%

“…5 Patients with right-sided endocarditis are complex requiring multiple subspecialty care services and have an overall in-house surgical mortality of 10% to 37%. 6 Cavo-atrial thrombus is also a major public health problem with a complicated patient population. 7 However, treatment for both of these entities is not well-defined.…”

Section: Introductionmentioning

confidence: 99%

Vacuum‐assisted extraction of ilio‐caval and right heart masses: A 5‐year single center experience

Newman¹,

Patel

Keeling

et al. 2020

J Card Surg

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“…Out of 53 retrieved searched articles, 42 met our inclusion criteria. The PRISMA flowchart is shown in Figure S1.…”

Section: Resultsmentioning

confidence: 99%

AngioVac for extraction of venous thromboses and endocardial vegetations: A meta‐analysis

et al. 2019

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Background AngioVac is a new device for filtering intravascular thrombi and emboli. Publications on the device are limited and underpowered to objectively estimate its safety and efficacy. We aimed to overcome this by performing a meta‐analysis on the results of AngioVac for treating venous thromboses and endocardial vegetations. Methods A systematic literature review was performed to identify all articles reporting cardiac vegetation and/or thrombosis extraction using AngioVac. Endpoints were successful removal, operative mortality, conversion to open surgery, hospital stay, recurrent thromboembolism, and follow‐up mortality. Random effect model was used, and pooled event rates (PERs) and incidence rate (IR) were calculated. Results A total of 42 studies with 182 patients (81 vegetation and 101 thrombosis) were included. Overall mean follow‐up times were 3.1 and 0.7 years in vegetation and thrombosis patients, respectively. The PERs for successful removal were 74.5 (confidence interval [CI]: 48.2‐90.2), 80.5 (CI: 70.0‐88.0), and 32.4 (CI: 17.0‐52.8) in vegetation, right atrial/caval venous thrombi, and pulmonary emboli (PE) patients, respectively. The PERs for operative mortalities were 14.6 (CI: 7.7‐25.8), 14.8 (CI: 8.5‐24.5), and 32.3 (CI: 15.1‐56.3), respectively. The PERs for conversion to open surgery were 25.0 (CI: 9.3‐51.9) and 12.3 (CI: 5.4‐25.6) in vegetation and thrombosis patients, respectively. The IR of recurrent thromboembolism was 0.18 per person per year (PPY) (CI: 0.00‐14.69) in vegetation and 0.19 PPY (CI: 0.08‐0.48) in thrombosis patients. IR of follow‐up mortality was 0.37 PPY (CI: 0.11‐1.21) in thrombosis patients. Conclusions AngioVac is a viable option for extracting right‐sided vegetations and right atrial/caval venous thrombi. Rates of successful extraction and mortality are significantly worse for PE.

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“…However, the use of VAT may potentially reduce this complication by preoperative debulking prior to lead extraction. In addition, VAT has also been used for the debulking of vegetations for tricuspid valve endocarditis …”

Section: Resultsmentioning

confidence: 99%

“…VAT may debulk these vegetations and allow for medical therapy without the need for surgical intervention. It has been used for critically ill patients with tricuspid valve endocarditis as a bridge to surgery . Furthermore, successful removal of malignant intracardiac masses have also been described and may be a potential utilization of VAT for inoperable cancer patients …”

Section: Discussionmentioning

confidence: 99%

The role of percutaneous vacuum-assisted thrombectomy for intracardiac and intravascular pathology

et al. 2018

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Vacuum-assisted thrombectomy (VAT) is a mechanical suction device that can be deployed to aspirate thrombi in the heart and vascular system. Successful percutaneous aspiration of iliocaval, right heart, and pulmonary arterial thrombi have been reported, in addition to the debulking of intravascular and intracardiac masses and vegetations. VAT is indicated for patients who are poor surgical candidates and/or have a contraindication to thrombolysis. This review discusses the mechanism, current results, potential clinical indications, and limitations of VAT for iliocaval and intracardiac mass removal.

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A novel approach to percutaneous removal of large tricuspid valve vegetations using suction filtration and veno‐venous bypass: A single center experience

Abstract: Percutaneous removal of large tricuspid valve vegetations is a safe and effective alternative for patients with TVE who carry high-surgical risk. © 2017 Wiley Periodicals, Inc.

Cited by 62 publications

References 24 publications

Vacuum‐assisted extraction of ilio‐caval and right heart masses: A 5‐year single center experience

Vacuum‐assisted extraction of ilio‐caval and right heart masses: A 5‐year single center experience

AngioVac for extraction of venous thromboses and endocardial vegetations: A meta‐analysis

The role of percutaneous vacuum-assisted thrombectomy for intracardiac and intravascular pathology

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