AngioVac-Assisted Vegetation Debulking in Endocarditis

Endocarditis remains associated with high morbidity and mortality despite advances in antimicrobial therapy and surgical management. Some patients are poor candidates for surgery due to comorbidities, extensive vegetations, or right-sided disease. AngioVac-assisted aspiration has emerged as a minimally invasive option for mechanical vegetation debulking in selected cases. We conducted a systematic review in accordance with PRISMA guidelines to identify published case reports describing the use of the AngioVac system for endocarditis. PubMed was searched from inception through September 2025. Data extracted included patient characteristics, vegetation location and size, microbiology, indications for AngioVac use, procedural details, complications, and clinical outcomes, with descriptive analyses performed. A total of 25 studies comprising 28 patients were included. The mean age was 46 years, with a balanced sex distribution. Right-sided endocarditis predominated, most commonly involving the tricuspid valve (78.6%). Large vegetations were frequent, with over half measuring ≥3.0 cm. Staphylococcus aureus was the most commonly identified pathogen. Indications for AngioVac use included septic pulmonary emboli, large vegetation burden, and persistent bacteremia despite antimicrobial therapy. Successful or partial vegetation debulking was achieved in 96.4% of cases, most commonly in right-sided disease, with low reported short-term mortality (3.6%). AngioVac-assisted aspiration appears to be a feasible and effective adjunctive strategy for carefully selected patients with infective endocarditis who are poor surgical candidates, particularly those with right-sided disease and large vegetations. While short-term outcomes are favorable, available evidence is limited, underscoring the need for prospective studies to better define long-term outcomes and optimal patient selection.