Surgical management is recommended for infective endocarditis (IE) when there is right heart failure due to severe tricuspid regurgitation, recurrent septic pulmonary emboli, persistent bacteremia, and large tricuspid valve vegetations (≥20 mm). However, sternotomy comes with strict eligibility limitations, including poor functional status, respiratory failure, and recent intravenous drug use. A 55-year-old woman with a history of intravenous drug use was diagnosed with persistent bacteremia in the setting of tricuspid valve endocarditis. Poor surgical candidacy prompted consideration of less invasive alternatives, including percutaneous aspiration. This case highlights the viability of AngioVac vegetectomy as an alternative treatment modality for persistent IE in poor surgical candidates. Surgical intervention is considered for right-sided native valve IE with vegetations ≥20 mm, persistent bacteremia, recurrent pulmonary septic emboli, or highly resistant organisms. The AngioVac system provides a minimally invasive treatment strategy for IE in patients who are otherwise ineligible for surgical intervention.
Zlaket et al. (Mon,) studied this question.