A novel approach, AngioVac use in right-sided infective endocarditis: a scoping review

Abstract

Infective endocarditis is an infection of microbial origin affecting the endocardial layer of the heart, mostly impacting the heart valves. Right-sided infective endocarditis mainly affects the tricuspid valve. In some cases where surgical management is indicated the patients might not be good candidates for surgery. The AngioVac drainage cannula (AngioDynamics, Latham, NY, USA) is a novel device used in debulking and suction of intravascular material. It has been reported in the literature as a novel treatment for patients with right-sided tricuspid valve endocarditis vegetations, where their size is reduced and the efficacy of antibiotics in clearing the bloodstream infection is enhanced. We conducted a thorough literature review to assess the uses of the AngioVac drainage cannula in the management of right-sided infective endocarditis vegetations and lesions. We collected all reported cases where the system was used for the management of right-sided infective endocarditis and performed an encompassing review of the literature. In the review, we found 65 cases reported using the AngioVac drainage cannula for the removal of right-sided infective endocarditis vegetations. Majority of the cases were successful with no complications (87.6%); 7 (10.7%) cases were successful but there were complications: 2 reported mortalities, 1 patient had worsening TR during follow-up, 3 had recurrence of the vegetation, and 1 patient remained bacteremic. There was only 1 reported failure. Four (6.1%) patients required postprocedural valvular surgery with 3 repairs and a single valve replacement. The AngioVac system is a possible bailout option for surgeons managing patients with right-sided infective endocarditis vegetations who are not ideal candidates for surgery. With increased reports on its use, it could be effective at reducing the microbiological burden with minimal complications.