A novel approach to percutaneous removal of large tricuspid valve vegetations using suction filtration and veno-venous bypass: A single center experience

Catheter Cardiovasc Interv. 2017 Nov 15;90(6):1009-1015. doi: 10.1002/ccd.27097. Epub 2017 May 4.

Abstract

Background: Tricuspid valve surgery has been the de facto standard treatment for tricuspid valve endocarditis (TVE) refractory to medical therapy. It is now possible to remove right-sided vegetations percutaneously using a venous drainage cannula with an extracorporeal bypass circuit.

Objectives: The purpose of our study is to describe our single-center experience of percutaneous tricuspid valve vegetation removal.

Methods: We reviewed the perioperative course of 33 consecutive patients with large tricuspid valve vegetations who carried high surgical risk.

Results: The cohort included 12 males and 21 females over a 40-month period with an average age of 37 years. A preponderance of patients carried an admitted or confirmed diagnosis of injection drug use (72.7%). Average vegetation size was 2.1 +/- 0.7 cm prior to the procedure with a 61% reduction in size after the procedure. All patients survived the procedure and 90.9% survived the index hospitalization. Three patients proceeded to elective tricuspid valve replacement due to worsening severity of tricuspid regurgitation.

Conclusion: Percutaneous removal of large tricuspid valve vegetations is a safe and effective alternative for patients with TVE who carry high-surgical risk. © 2017 Wiley Periodicals, Inc.

Keywords: AngioVac; percutaneous suction filtration; tricuspid valve endocarditis; veno-venous bypass.

MeSH terms

  • Adult
  • Candidiasis / complications*
  • Candidiasis / diagnosis
  • Candidiasis / therapy
  • Cardiac Catheterization / instrumentation*
  • Echocardiography
  • Endocarditis / complications*
  • Endocarditis / diagnosis
  • Endocarditis / surgery
  • Equipment Design
  • Female
  • Femoral Vein
  • Follow-Up Studies
  • Heart Valve Diseases / diagnosis
  • Heart Valve Diseases / microbiology
  • Heart Valve Diseases / surgery*
  • Humans
  • Jugular Veins
  • Male
  • Methicillin-Resistant Staphylococcus aureus / isolation & purification
  • Staphylococcal Infections / complications*
  • Staphylococcal Infections / diagnosis
  • Staphylococcal Infections / surgery
  • Suction / instrumentation
  • Surgery, Computer-Assisted / methods*
  • Treatment Outcome
  • Tricuspid Valve / diagnostic imaging*
  • Tricuspid Valve / microbiology