Percutaneous Mechanical Aspiration vs Valve Surgery for Tricuspid Valve Endocarditis in People Who Inject Drugs

Veve, Michael P; Akhtar, Yasir; McKeown, Peter P.; Morelli, Morgan K; Shorman, Mahmoud

doi:10.1016/j.athoracsur.2020.08.036

Cited by 17 publications

(10 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A percutaneous approach initially may allow a staged approach to tricuspid valve replacement as ideally cultures should be negative prior to implantation of prosthetic material. We have previously reported 1 year mortality similar between surgical and percutaneous approach with the Penumbra System 27 as a part of a multicenter study design.…”

Section: Discussionmentioning

confidence: 99%

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

Akhtar¹,

Walker²,

Shakur

et al. 2021

Cathet Cardio Intervent

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

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

Akhtar¹,

Walker²,

Shakur

et al. 2021

Cathet Cardio Intervent

View full text Add to dashboard Cite

show abstract

“…[3][4][5] Others have reported tricuspid vegetation debulking using the Penumbra Indigo system and shown comparable 12-month mortality with that of valve surgery. 6 There are a few considerations for TV surgery in patients with IVDU and endocarditis: (a) the risk of relapse of IVDU post-surgery is as high as 70%; and (b) the risk of recurrent endocarditis is as high as 50% after surgery. 7 As such, there is reluctance of surgeons to operate given morbidity and mortality.…”

Section: Discussionmentioning

confidence: 99%

Tricuspid valve vegetation debulking using the AngioVac system

Bangalore

Alviar

Vlahakis

et al. 2021

Cathet Cardio Intervent

View full text Add to dashboard Cite

show abstract

“…215 Likewise, for IV drug users with infective endocarditis, percutaneous debulking of large tricuspid valve vegetations by mechanical aspiration might serve as treatment or a bridging strategy to definitive surgery. 216,217 Transcatheter aortic valve replacement is generally contraindicated in the context of endocarditis; however, it may still serve as a feasible option in exceptional or emergency cases. 218 There is a noticeable trend to be therapeutically more aggressive in patients with imminent risk of embolism 46 and increasing age.…”

Section: Surgical Advancesmentioning

confidence: 99%

Anesthesia Considerations in Infective Endocarditis

et al. 2022

View full text Add to dashboard Cite

The management of infective endocarditis is complex and inherently requires multidisciplinary cooperation. About half of all patients diagnosed with infective endocarditis will meet the criteria to undergo cardiac surgery, which regularly takes place in urgent or emergency settings. The pathophysiology and clinical presentation of infective endocarditis make it a unique disorder within cardiac surgery that warrants a thorough understanding of specific characteristics in the perioperative period. This includes, among others, echocardiography, coagulation, bleeding management, or treatment of organ dysfunction. In this narrative review article, the authors summarize the current knowledge on infective endocarditis relevant for the clinical anesthesiologist in perioperative management of respective patients. Furthermore, the authors advocate for the anesthesiologist to become a structural member of the endocarditis team.

show abstract

Percutaneous Mechanical Aspiration vs Valve Surgery for Tricuspid Valve Endocarditis in People Who Inject Drugs

Cited by 17 publications

References 27 publications

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

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

Tricuspid valve vegetation debulking using the AngioVac system

Anesthesia Considerations in Infective Endocarditis

Contact Info

Product

Resources

About