AngioVac-assisted debulking achieved approximately 80% removal of tricuspid vegetation in a patient with severe MRSA endocarditis, serving as a successful bridge to clinical stabilization.
Case Report (n=1)
AngioVac aspiration provides a viable minimally invasive alternative for debulking tricuspid valve vegetations in hemodynamically unstable patients with MRSA endocarditis who are prohibitive surgical risks.
Abstract Background Methicillin-resistant Staphylococcus aureus (MRSA) infective endocarditis (IE) involving the tricuspid valve is increasingly prevalent among intravenous drug users (IVDU). It carries a high risk of septic pulmonary emboli and respiratory failure. Standard therapy—intravenous antibiotics and surgical valve replacement—is often contraindicated in hemodynamically unstable patients. The AngioVac aspiration system offers a minimally invasive alternative to reduce vegetation burden and stabilize critically ill individualsCase:A 38-year-old female with a history of IVDU, untreated hepatitis C, and seizure disorder presented with MRSA bacteremia, tricuspid valve IE, and bilateral septic pulmonary emboli. Her hospital course was complicated by aspiration pneumonia, empyema, massive hemoptysis, and cardiac arrest requiring resuscitation. Due to prohibitive operative risk, cardiothoracic surgery deferred valve replacement. Interventional cardiology performed AngioVac-assisted debulking, achieving approximately 80 % removal of the tricuspid vegetation. Despite persistent fevers, subsequent right-lung VATS decortication, bronchial artery embolization, tracheostomy, and PEG placement led to gradual clinical stabilization and discharge to long-term acute care. Discussion This case demonstrates the therapeutic role of AngioVac as a bridge to recovery in severe right-sided MRSA endocarditis when surgery is not feasible. The procedure effectively decreased vegetation load and embolic potential while maintaining hemodynamic stability. Adjunctive thoracic and critical care interventions were vital for managing respiratory and infectious sequelae. Multidisciplinary coordination across cardiology, infectious disease, thoracic surgery, and critical care was essential for survival. Conclusion AngioVac provides a viable alternative or bridge to surgery for unstable patients with MRSA tricuspid endocarditis and multisystem complications. Its integration into multidisciplinary management may improve outcomes when conventional surgical approaches are contraindicated. This abstract is funded by: None
Fox et al. (Fri,) conducted a case report in MRSA tricuspid endocarditis (n=1). AngioVac aspiration system was evaluated on Tricuspid vegetation removal. AngioVac-assisted debulking achieved approximately 80% removal of tricuspid vegetation in a patient with severe MRSA endocarditis, serving as a successful bridge to clinical stabilization.
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