Clinical outcomes of percutaneous debulking of tricuspid valve endocarditis in intravenous drug users

Abstract

Objectives A retrospective case series of a percutaneous approach to debulk tricuspid valve endocarditis (TVE) using an 8 French mechanical aspiration system in patients with a history of intravenous drug use (IVDU) was reported. IVDU associated TVE is increasing in the United States and is associated with high mortality despite early surgical debridement. Patients with advanced disease, shock, and respiratory failure may not be candidates for surgical debridement or replacement. These patients have recurrent events despite medical therapy Methods About 25 patients with IVDU associated TVE with persistent bacteremia confirmed by repeat blood cultures after 72 hr of sensitivity directed antibiotics and presence of pulmonary emboli confirmed by computed tomographic (CT) scan, who had undergone percutaneous aspiration were included. Patients were all deemed high risk for surgical debridement by a CT surgeon and evaluated by an infectious disease consultant. Procedures were performed under moderate sedation with intracardiac echo and a steerable guide with a CAT8 Penumbra aspiration catheter. Results There were no intraprocedural deaths or complications. About 36% had septic shock on presentation. Survival of index hospitalization was 88%. Repeat blood cultures showed no growth on all surviving patients. Readmission rate was 4% (n = 1) at 1 month. About 40% (n = 2) patients with septic shock survived at 1 month compared with 100% survival (n = 20) in those without shock. Presence of septic shock was associated with reduced survival at 1 month (p < .01). Conclusion Percutaneous mechanical aspiration with an 8 Fr system is a feasible, minimally invasive alternative to surgical debulking. Mortality remains high in those presenting with septic shock. Further studies are needed to evaluate long‐term outcomes.

Percutaneous mechanical aspiration in patients with right‐sided infective endocarditis: An analysis of the national inpatient sample database—2016–2020

“…Our study revealed an upward trend in PMA use in the management of RSIE which has been reflected in the literature, as there has been an increase in case series and registry data showing the expansion of the motives and applications of PMA in RSIE 12–17 . PMA has been predominately used in cases of RSIE as an adjunct to management where a response to appropriate antimicrobial therapy is not achieved or immediate valve surgery is not feasible.…”

“…Our study revealed an upward trend in PMA use in the management of RSIE which has been reflected in the literature, as there has been an increase in case series and registry data showing the expansion of the motives and applications of PMA in RSIE. [12][13][14][15][16][17] PMA has been predominately used in cases of RSIE as an adjunct to management where a response to appropriate antimicrobial therapy is not achieved or immediate valve surgery is not feasible. The indications for PMA have included: (1) reduction of the size of large (≥20 mm) lead vegetations to decrease the likelihood of SPE at the time of CIED removal 13 ; (2) removal of small vegetations in patients with patent foramen ovale 13 ; (3) reduction in the duration of BSI and/ or sepsis in patients who are not "open" surgical candidates such as the case in select PWID cases 16,17 ; and (4) for those who develop severe tricuspid valve regurgitation as a consequence of RSIE, PMA may lead to source control which would facilitate a referral to rehabilitation to treat the underlying addiction in PWID.…”

Minimally invasive procedures for right side infective endocarditis: A targeted literature review

“…Excluding duplicates, 41 case reports and 37 irrelevant studies, 11 studies were included in this targeted literature review. [16][17][18][19][20][21][22][23][24][25][26] Among these, 2 were abstracts and 9 were manuscripts.…”

Case Series of Percutaneous Mechanical Aspiration of Mitral Valve Endocarditis

“…Percutaneous aspiration of tricuspid valve IE has been reported. 5 , 6 To our knowledge, percutaneous mechanical aspiration of mitral valve vegetation has not been previously reported. Compared with tricuspid valve aspiration, significant challenges exist, including transseptal access and the need for cerebral embolic protection given the risk of systemic embolism.…”