AngioVac for Vegetation Debulking in Right-sided Infective Endocarditis: A Systematic Review and Meta-Analysis

Mhanna, Mohammed; Beran, Azizullah; Al‐Abdouh, Ahmad; Jabri, Ahmad; Sajdeya, Omar; Al‐Aaraj, Ahmad; Alharbi, Abdulmajeed; Khuder, Sadik A.; Eltahawy, Ehab

doi:10.1016/j.cpcardiol.2022.101353

Cited by 18 publications

(18 citation statements)

References 48 publications

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“…The AngioVac System has become a viable alternative to surgery to treat tricuspid valve/prosthesis and intravenous leads for permanent rhythm devices in patients with high surgical risk (7)(8)(9). Recent reports (10)(11)(12) showed its safety and effectiveness in different scenarios mostly involving the venous system and the right heart chambers, demonstrating its versatility as an option also to treat high-risk patients.…”

Section: Discussionmentioning

confidence: 99%

“…Recent reports (10)(11)(12) showed its safety and effectiveness in different scenarios mostly involving the venous system and the right heart chambers, demonstrating its versatility as an option also to treat high-risk patients. More than having complete control of the infection, the first aim of the procedure is to debulk the vegetation size, lowering the embolic risk and the microbic burden with a positive impact on the effect of antibiotic therapy, thereby enhancing its effectiveness and controlling systemic involvement (9).…”

Section: Discussionmentioning

confidence: 99%

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Case report: Treatment of left-sided valve endocarditis using the Transapical AngioVac System and cerebral embolism protection device: A case series

Fiocco

Colli

Besola

2023

Front. Cardiovasc. Med.

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The AngioVac System (AngioDynamics, Latham, NY) was developed for the treatment of right-sided heart and intravenous masses. Lately, it has been employed to deal with left-sided heart masses, in particular, native valve endocarditis (NVE) and valve prostheses endocarditis (VPE) in high-risk patients. Left-sided heart endocarditis has a high morbidity, and it also has a high mortality when open heart surgery is performed. Recently, patients presenting with left NVE and VPE have been treated with the off-label use of the AngioVac System even if the solution presents a considerable cerebral embolization risk issue due to the risk of fragmentation rather than a complete en-bloc aspiration of the masses. A percutaneous cerebral embolism protection system is currently used in TAVI procedures, especially when the native valve presents extensive calcifications and consequent significant embolic risks. We hereby present a clinical case series of a combined utilization of the AngioVac System and cerebral embolism protection system Triguard (Keystone Heart Ltd., Herzliya, Israel) to treat left NVE and VPE in prohibitive-surgical-risk patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Case report: Treatment of left-sided valve endocarditis using the Transapical AngioVac System and cerebral embolism protection device: A case series

Fiocco

Colli

Besola

2023

Front. Cardiovasc. Med.

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“…This study showed the successful outcomes of right-sided vegetation removal, bacteraemia clearance, and relatively low complications in candidates with high surgical risk. 2 All these accounts demonstrated a successful debulking of RSIE vegetations in the tricuspid valve or pulmonary valve, but none illustrated application in EVE. Exploiting this, we replicated the successful debulking of EV vegetation by AngioVac ® ( Figure 2C ).…”

Section: Discussionmentioning

confidence: 99%

“…AngioVac ® , a percutaneous vacuum-assisted aspiration system has gained increased notoriety as a minimally invasive modality for evacuation and debulking of large vegetations. 2 …”

Section: Introductionmentioning

confidence: 99%

Endocarditis of the forgotten valve: vacuum-assisted aspiration (AngioVac) of the eustachian valve: a case report

Shah

Haq

Golzarian

et al. 2023

European Heart Journal - Case Reports

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Background Eustachian valve endocarditis is a rare entity that traditionally has been treated with antibiotics or surgery, if refractory to antibiotic treatment. Case Summary A 64-year-old man presented with right shoulder pain and new onset hypoxia. His blood cultures were positive for Methicillin sensitive staphylococcal aureus one month ago and he was treated with antibiotics at that time. Blood cultures during this admission were again positive for MSSA. Trans-esophageal echocardiogram showed a large independently mobile echogenic density consistent with vegetation (3.0 × 1.6 cm) on the eustachian valve. Patient was a poor surgical candidate due to his multiple comorbidities, therefore a noninvasive procedure AngioVac® was selected. Discussion In the setting of infective endocarditis refractory to antibiotics, the large-bore percutaneous mechanical aspiration (AngioVac®, Angiodynamics, Latham, NY) system is gaining increasing momentum as the treatment of choice over standard surgical intervention for debulking large vegetations. AngioVac® has provided a minimally invasive and effective measure especially in those unable to tolerate surgery. The novel percutaneous technique is linked to great success in right sided endocarditis, with tricuspid valve accounting for majority of the cases. However, in rare instances the eustachian valve may be involved. To our knowledge, we report the first case of eustachian valve endocarditis treated with AngioVac®.

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“…It is designed for removal of intravascular material using extracorporeal veno‐venous bypass circuit. It has also been used for the debridement of vegetation seen in right sided endocarditis and for right atrial tumors 11–15 …”

Section: Introductionmentioning

confidence: 99%

Effectiveness of the vacuum assisted aspiration AngioVac system in the removal of intravascular masses

Nickell

Sergev

Alberto

et al. 2023

Cathet Cardio Intervent

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Background: Invasive procedures used to manage intravascular masses such as vegetation from endocarditis, deep vein thrombosis, and septic emboli are associated with high rates of complications and mortality, especially in patients with several pre-existing comorbidities. A minimally invasive technique that has become more popular in recent years is the AngioVac procedure. This singlecentered, retrospective study focuses on patient presenting comorbidities and indications for the procedure as well as postprocedural outcomes.Methods: A total of 33 patients who underwent an AngioVac procedure at Sanford Health between March 2014 and October 2019 was reviewed. Data were collected on pre-existing comorbidities, indication of procedure, length of stay, and postoperative outcomes.Results: We evaluated a total of 33 patients who underwent an AngioVac procedure for removal of intravascular mass. The most common indications for the procedure were endocarditis (24/33, 73%); intracardiac mass (5/33, 15%); and deep vein thrombosis or pulmonary embolism (2/33, 6%). Post-procedural blood transfusion was required in nearly half (15/33, 45%). Almost all patients (31/33, 94%) required intraoperative vasopressor use. Nearly all patients (32/33, 97%) were directed to the intensive care unit following the procedure with an average length of stay of 8 days (interquartile range: 3−13). Most common complications seen after the procedure were shock requiring vasopressors, (13/33, 39%), pleural effusion (9/33, 27%), and sepsis (4/33, 12%). Procedural success in this single-centered experience was 85% (28/33), which was defined as size reduction of the initial vegetation by >50% in the absence of severe intraoperative complications and absence of need for further valvular surgical intervention. Conclusion:For surgically high-risk patients, the AngioVac procedure may offer a less invasive option in the management of right sided endocarditis requiring vegetation debulking, intravascular thrombi or cardiac masses.

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AngioVac for Vegetation Debulking in Right-sided Infective Endocarditis: A Systematic Review and Meta-Analysis

Cited by 18 publications

References 48 publications

Case report: Treatment of left-sided valve endocarditis using the Transapical AngioVac System and cerebral embolism protection device: A case series

Case report: Treatment of left-sided valve endocarditis using the Transapical AngioVac System and cerebral embolism protection device: A case series

Endocarditis of the forgotten valve: vacuum-assisted aspiration (AngioVac) of the eustachian valve: a case report

Effectiveness of the vacuum assisted aspiration AngioVac system in the removal of intravascular masses

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