Outcomes With Percutaneous Debulking of Tricuspid Valve Endocarditis

Abstract

BACKGROUND: In patients with tricuspid valve infective endocarditis, percutaneous debulking is a treatment option. However, the outcomes of this approach are less well known. METHODS: We performed a retrospective analysis of all patients who underwent percutaneous vegetation debulking for tricuspid valve infective endocarditis from August 2020 to November 2022 at a large academic tertiary care public hospital. The primary efficacy outcome was procedural success defined by clearance of blood cultures. The primary safety outcome was any procedural complication. For the composite outcome of in-hospital mortality or heart block, outcomes were compared (sequential noninferiority and superiority) with published surgical outcomes data. RESULTS: Of the 29 patients with tricuspid valve infective endocarditis who underwent percutaneous debulking, the average age was 41.3±10.1 years, all patients had septic pulmonary emboli with 27 (93.1%) patients having cavitary lung lesions before the procedure. For the efficacy outcomes, 28 patients (96.6%) had clearance of cultures after their procedure, mean white blood cell count significantly decreased from 16.8±1.4×10 3 to 12.6±1.0×10 3 per µL ( P <0.01), and mean body temperature significantly decreased from 99.8F ±0.30 to 98.3F ±0.20 ( P <0.001) post-procedure. For safety outcomes, there were no procedural complications (0%). Two patients (6.9%) died during the follow-up period, both during the index hospitalization due to severe necrotizing pneumonia. When compared with published data on surgical outcomes, percutaneous debulking was noninferior and superior for the composite of in-hospital death or heart block (noninferiority, P <0.001; superiority, P =0.016). CONCLUSIONS: Percutaneous debulking is feasible, effective, and safe in treating patients with tricuspid valve infective endocarditis refractory to medical therapy.

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.…”

“…This would then serve as a bridge to safer surgery with lower risk of infecting the prosthetic valve from injection drug use relapse 12 . Another common application is (5) elimination of the risk of recurrent SPE in patients despite antimicrobial therapy and at high operative risk, 12 This expansion in the application of PMA in multiple facets of management of RSIE may explain the increasing trends in its utilization as demonstrated in our investigation. These applications may also help in decision‐making for timing of intervention in PMA in RSIE.…”

“…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. This would then serve as a bridge to safer surgery with lower risk of infecting the prosthetic valve from injection drug use relapse 12 . Another common application is (5) elimination of the risk of recurrent SPE in patients despite antimicrobial therapy and at high operative risk, 12 This expansion in the application of PMA in multiple facets of management of RSIE may explain the increasing trends in its utilization as demonstrated in our investigation.…”

Percutaneous Debulking of a Tricuspid Valve Papillary Fibroelastoma: A Rare Presentation and Management Approach

“…Recent studies have suggested that percutaneous debulking of tricuspid valve infective endocarditis is feasible and safe. 2 Percutaneous debulking offers the advantage of delaying valve replacement in patients who are young and serves as a useful temporizing measure in patients with septic shock or, as observed in this instance, individuals at higher risk for cardiac surgery due to a recent cerebral vascular accident.…”