Case Report

AngioVac System Used for Vegetation Debulking in a Patient with Tricuspid Valve Endocarditis: A Case Report and Review of the Literature

Table 1

Reports on the use of the AngioVac device in treatment of RSIE.

Author/yearType of publicationAge/sexOrganismLocation of vegetationIndication for procedurePreprocedural vegetation sizeReduction in vegetation sizePostprocedural bacteremiaTricuspid regurgitation (TR) progressionOutcome

Todoran et al. [20] (2011)Case report53 y/o, MHaemophilus parainfluenzaeSVC/RA junctionLack of response to appropriate antimicrobial therapy1.7 cm100% removalResolvedNot reportedImprovement with no further sequel

Jones et al. [21] (2017)Case report25 y/o, FCandida albicans(i) SV/RA junction attached to ICD RV lead(i) Persistent fungemia despite appropriate antimicrobial therapySV/RA junction: 6.1 cm × 1.65 cmRemoval of 6 cm vegetation (residual vegetation size not reported)ResolvedNot reportedImprovement with no further sequel
(ii) RA(ii) Recurrent septic emboliRA: −2.1 cm × 1.6 cm

Schaerf et al. [10] (2016)Retrospective study (20 patients)Mean age: 76 ± 118 coagulase-negative SA13 ICD; 7 pacemaker(i) Lack of response to appropriate antimicrobial therapyAverage size: 3.6 cm ± 1.2 cmNot mentionedResolved in 19/20 patientsNot reportedNot reported clearly
3 MSSA
4 MRSA
3 Streptococci
Sex not reported
1 Enterococcus
1 Polymicrobial
(ii) Bridge to percutaneous lead removal

Thiagaraj et al. [22] (2017)Case seriesPatient 1: 35 y/o, MMSSASVC/RA junction extending into TV(i) Lack of response to appropriate antimicrobial therapy4.5 cm100% removalResolvedNot reportedImprovement with no further sequel
(ii) Vegetation size ≥ 20 mm
Patient 2: 28 y/o, FMRSATV(i) Lack of response to appropriate antimicrobial therapy2.2 × 1.7 cm100% removalResolvedNot reportedMRSA bacteremia recurrence, cardiac arrest, and death 5 days post procedure
(ii) Vegetation size ≥ 20 mm
Patient 3: 53 y/o, FEnterococcus faecalisBioprosthetic TV(i) Vegetation size ≥ 20 mm3.2 cm25–50% reduction in sizeResolvedImprovement from moderate to mildImprovement with mild worsening of TR
(ii) Worsening of TV regurgitation

Divekar et al. [7] (2013)Case report17 y/o, MMSSAPulmonary valveRecurrent pulmonary embolism despite antimicrobial therapy3.5 cm × 1.5 cmSignificant reduction (residual vegetation size not reported)ResolvedNot reportedClinical improvement with no further sequel

George et al. [23] (2017)Retrospective study (33 patients)Mean age: 37 ± 1214 MRSATVLack of response to appropriate antimicrobial therapy2.1 cm ± 0.7 cmAverage of 61% reduction in sizeResolved in 28/33 patients14 patients: worsening of TR (3 required elective TV repair)28 patients: improvement with no further sequel
11 MSSA
12, M3 polymicrobial1 patient: developed postprocedural cardiac tamponade requiring pericardiocentesis
21, F5 Candida3 patients: death

Makdisi et al. [16] (2016)Case report24 y/o, MMRSATVLack of response to appropriate antimicrobial therapy0.9 cm × 0.7 cm80% reduction in sizeResolvedNo changeClinical improvement with no further sequel
0.7 cm × 1 cm

Patel et al. [11] (2013)Case seriesPatient 1: 59 y/o, MSAICD lead(i) Vegetation size ≥ 20 mm3 cm × 2 cmSignificant reduction (residual vegetation size not reported)ResolvedImprovement in degree of TRClinical improvement with no further sequel
(ii) Bridge to percutaneous lead removal
Patient 2: 82 y/o, MGroup B Streptococcus(i) Pacemaker lead(i) Vegetation size ≥ 20 mm(i) Pacemaker lead: 4 cm × 1.5 cmSignificant reduction (residual vegetation size not reported)Not reportedNot reportedNot reported
(ii) TV(ii) Bridge to percutaneous lead removal(ii) TV: 0.5 cm × 1.1 cm
Patient 3: 56 y/o, FMRSAPacemaker lead(i) Vegetation size ≥ 20 mm3.5 cm × 1.7 cmSignificant reduction (residual vegetation size not reported)Persistent bacteremiaWorsening of TRFormation of new vegetation with severe TR that required TV repair
(ii) Bridge to percutaneous lead removal

Dalia et al. [12] (2016)Case report26 y/o, FNot reportedTVBridge to pulmonary artery aneurysm repair1.6 cm × 0.8 cmSignificant reduction (residual vegetation size not reported)Not reportedNot reportedUnderwent pulmonary artery aneurysm repair successfully; clinical improvement with no further sequel

Hosoba et al. [24] (2015)Case seriesPatient 1: 67 y/o, FMRSARANot reported1.5 cm × 1.5 cmNot reportedResolvedNot reportedClinical improvement with no further sequel
Patient 2: 33 y/o, MEnterobacter cloacaeRA near Chiari networkNot reported2.2 cm × 0.6 cmNot reportedResolvedNot reportedClinical improvement with no further sequel
Patient 3: 70 y/o, MMSSASVC/RA junctionVegetation size  20 mm3.4 cm × 1.3 cmNot reportedResolvedNot reportedClinical improvement with no further sequel

M: male, F: female, y/o: years old, SVC: superior vena cava, RA: right atrium, ICD: implantable cardioverter defibrillator, RV: right ventricle, SA: Staphylococcus aureus, MSSA: methicillin-sensitive Staphylococcus aureus, MRSA: methicillin-resistant Staphylococcus aureus, TV: tricuspid valve, TR: tricuspid regurgitation.