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

Abstract

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.

Endovascular Treatment of Right Heart Masses Utilizing the AngioVac System: A 6-Year Single-Center Observational Study

“…The indication for the procedure was a right heart mass in 52.6% of cases; intraprocedural success, defined as >70% mass removal, was achieved in nearly 60% of patients with right heart masses [ 13 ]. Our own results coincide with previously published data, as seen in Table 4 , demonstrating good intraoperative success [ 5 , 7 , 14 – 16 ]. Likewise, these results also support the use of AngioVac as a treatment option for critically ill patients with right-sided heart masses, as seen in Figure 2 .…”

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.…”

“…However, two studies with more severe patients reported patients with a worsening degree of tricuspid regurgitation, though it was unclear the degree to which the worsening severity was due to the debulking procedure. 21,24 Furthermore, a recent study analyzing data from the registry to assess safety and procedural outcomes of using the AngioVac at University of California, Los Angeles did not report any valve damage. 28 In all, more data are needed in evaluating the impact of such procedure on tricuspid valve damage as part of the safety profile of the AngioVac system.…”

“…In this review, when comparing tricuspid regurgitation before and after procedures, one study found most cases remained stable or slightly improved while one case required valve replacement due to persistent severe valve regurgitation 18 The author concluded with supportive language in terms of the safety profile of the AngioVac. However, two studies with more severe patients reported patients with a worsening degree of tricuspid regurgitation, though it was unclear the degree to which the worsening severity was due to the debulking procedure 21,24 . Furthermore, a recent study analyzing data from the registry to assess safety and procedural outcomes of using the AngioVac at University of California, Los Angeles did not report any valve damage 28 .…”

Modified AngioVac System use With Extracorporeal Membrane Oxygenation in a Child With Fontan Thrombosis

“…6,7 Case-reports describe safe right heart thrombi extraction. [7][8][9][10][11] Although no anatomical, age, or weight restrictions exist, AVS has been rarely used in Fontan physiology. 12,13 One case report describes the use of AVS concurrent with veno-arterial-ECMO (VA-ECMO) in a previously healthy, 72 kg 12-year-old with cannula-tip thrombus.…”