Percutaneous Mechanical Aspiration of Left-Sided Intracardiac Masses for Prohibitive Surgical Candidates: A Single-Center Experience

Background Percutaneous mechanical aspiration (PMA) of intracardiac masses is mostly described for right-sided lesions. Left-sided masses are typically managed medically or surgically, with limited data regarding transcatheter removal. PMA is currently considered off-label; however, it may have advantages to debulk lesions and reduce morbidity in high risk patients. Methods We performed an observational study of 7, prohibitive surgical candidates who underwent transseptal PMA of mitral valve (MV) masses. Baseline characteristics, echocardiographic findings, procedural details, and in-hospital and short-term outcomes were collected. The primary procedural efficacy end point included procedural success defined by ≥70% mass removal and procedure-related mortality. The primary composite safety end point included in-hospital mortality, cerebrovascular accident, increased valvular regurgitation, and major structural complications. Results Seven patients were included. The mean age was 77.9 ± 6.1 years; 71% were women, and the median predicted Society of Thoracic Surgery mortality score was 19.5%. All patients had echocardiographic evidence of large (>1 cm) left-sided masses involving the MV or adjacent structures. The primary efficacy end point was seen in 100% of cases. The primary composite outcome was seen in 14.3%, driven by worsening MV regurgitation. Procedure and fluoroscopy durations demonstrated a downward trend with increased experience. All patients survived to discharge and 30-day survival was 85.7%, with 1 noncardiac death. Conclusions Transseptal PMA is feasible for debulking of MV masses in prohibitive surgical candidates. In this early experience, the technique achieved success with low procedural morbidity and encouraging short-term outcomes. Larger studies are needed to define patient selection criteria and long-term efficacy.