Scoping review of percutaneous mechanical aspiration for valvular and cardiac implantable electronic device infective endocarditis

Abstract

Background: Percutaneous mechanical aspiration (PMA) of intravascular vegetations is a novel strategy for management of patients with infective endocarditis (IE) who are at high risk of poor outcomes with conventional cardiac surgery. However, clear indications for its use as well as patient outcomes are largely unknown.

Objectives: To conduct a scoping review of the literature to summarize patient characteristics and outcomes of those undergoing PMA for management of IE.

Methods: Two independent reviewers screened abstracts and full text for inclusion and independently extracted data.

Data sources: MEDLINE, Embase, and Web of Science.

Study eligibility criteria: Studies published until February 21, 2023, describing the use of PMA for management of patients with cardiac implantable electronic device (CIED) or valvular IE were included.

Assessment of risk of bias: As this was a scoping review, risk of bias assessment was not performed.

Methods of data synthesis: Descriptive data was reported.

Results: We identified 2252 titles, of which 1442 abstracts were screened, and 125 full text articles were reviewed for inclusion. Fifty-one studies, describing a total of 294 patients who underwent PMA for IE were included in our review. Over 50% (152/294) of patients underwent PMA to debulk cardiac implantable electronic device lead vegetations prior to extraction (152/294), and 38.8% (114/294) of patients had a history of drug use. Patient outcomes were inconsistently reported, but few had procedural complications, and all-cause in-hospital mortality was 6.5% (19/294).

Conclusions: While PMA is a promising advance in the care of patients with IE, higher quality data regarding patient outcomes are needed to better inform the use of this procedure.

Keywords: AngioVac; Infective endocarditis; Percutaneous mechanical aspiration; Vegectomy.