Percutaneous Vegetectomy for Severe Right-Sided Infective Endocarditis Complicated by Cardiac Arrest and Multiorgan Failure

BACKGROUND: Right-sided infective endocarditis (RSIE) is a life-threatening condition predominantly affecting the tricuspid valve. For patients with prohibitive surgical risk, percutaneous vegetectomy (PV) is emerging as a viable alternative. CASE SUMMARY: A 38-year-old man with active intravenous drug use presented with cardiac arrest, profound shock, and multiorgan dysfunction. Echocardiography revealed a large tricuspid valve vegetation (2.0 × 3.1 cm) with severe regurgitation. Because of high surgical risk, he underwent salvage PV using the AngioVac system. The procedure achieved 90% debulking, leading to marked hemodynamic improvement and successful weaning of vasoactive agents. He was subsequently discharged to complete antimicrobial therapy pending reassessment for definitive surgery. DISCUSSION: Although PV is increasingly used for RSIE, data regarding its use in extreme hemodynamic instability remain limited. Our case highlights its utility as a temporizing, life-saving intervention to reduce microbial burden and provide critical source control when definitive surgical debridement is not feasible. TAKE-HOME MESSAGES: PV is a viable rescue strategy for RSIE in high-risk patients. It provides critical source control to stabilize hemodynamics and bridge patients to recovery or definitive surgery.