C-81 | Experience with Angiovac Debulking of Tricuspid Valve Endocarditis at an Academic Tertiary Care Hospital

The Angiovac mechanical aspiration system has recently emerged in the literature for its use in the percutaneous debulking of intracardiac vegetations and masses. We present our unique long-term experience with the Angiovac system in patients with tricuspid valve infective endocarditis (TVIE) and high or prohibitive operative risk. We performed a retrospective analysis on all patients who underwent percutaneous Angiovac vegetation debulking in the setting of TVIE from January 2017 to December 2023 at a large academic tertiary care hospital. Of the 62 patients who underwent Angiovac Debulking, 32 (51.6%) were women, mean age was 38.72 ± 12.1 years, and 48 (77.4%) had a history of intravenous drug use. 46 (79.3%) patients were diagnosed with Staphylococcal Aureus endocarditis, of which 22 (37.9%) were methicillin resistant. 59 (95.2%) patients were septic at the time of procedure, and 54 (89%) patients had clearance of blood cultures with an average of 7.5 ± 6.3 days post-procedure. Average length of vegetation was 20.709 ± 7.67 mm. During their hospitalization, none experienced vascular injury or bleeding, or a stroke. 1 (1.6%) patient experienced a pulmonary embolism, 5 (8.0%) patients experienced a systemic embolism, and 26 (41.9%) patients required blood transfusion. Intraoperative trans-esophageal echocardiogram demonstrated that the severity of tricuspid regurgitation did not worsen in 54 (87.1%) patients following debulking. 5 (8.0%) patients died during initial hospitalization. Of the 62 patients, 45 (72.6%) had documented follow-up, at an average of 2.37 ± 1.95 years post-procedure. From this group, 8 (17.8%) patients experienced recurrent endocarditis requiring hospitalization. 7 (15.6%) patients died during the follow-up period. Including both initial hospitalization and last known follow-up, 5 (8%) patients required surgical TV repair, and 1 (1.5%) patient required transcatheter edge-to-edge repair of the TV. This retrospective analysis adds to the growing literature that Angiovac debulking may be a safe and effective long-term alternative to cardiac surgery in patients with TVIE and elevated perioperative risk.