VACUUM IT OUT: SINGLE CENTER EXPERIENCE WITH ANGIOVAC FOR MANAGEMENT OF RIGHT HEART THROMBUS AND ENDOCARDITIS

Background
Historically management of large right heart thrombus and endocarditis has required surgical intervention which carries an elevated operative mortality (6-10%) as well as high postoperative morbidity from right heart failure. AngioVac offers a percutaneous approach to debulking these masses in a minimally invasive technique with significantly less mortality and morbidity.

Methods
We reviewed 22 cases that were performed at our single center since 2017. A multidisciplinary team approach was used to identify patients that would benefit from this procedure. The device was used for tricuspid valve/RVOT vegetation(s), RV lead extraction and RA/RV thrombus. Clinical, procedural and outcomes data were reviewed.

Results
Of the 22 cases performed at our institution, the majority of cases were used for right sided infective endocarditis (82%) followed by RA/RV thrombus or foreign body (18%). The mean age was 38 ± 13 and 68% were females. 18% of the patients had LV dysfunction. Among the patients with infective endocarditis majority of them were infected with Methicillin Sensitive Staph Aureus. 100% of the cases had greater than 50% reduction of vegetation/thrombus burden by echo. Procedural survival was 100%, and survival to discharge was 86%.

Conclusions
AngioVac provides an alternative and minimally invasive method of debulking medically resistant right sided infective endocarditis and right sided thrombus, especially in patients that have high surgical and re-infection risk.