Percutaneous debulking of large vegetations

Percutaneous debulking of large vegetations


Percutaneous debulking of large vegetations in infective endocarditis is being followed, especially in cardiac implantable device related infections. It is useful in reducing the risk of massive embolism during lead extraction [1]. In a report of six cases done along with lead extraction, there were no operative deaths or clinically significant embolic events [1]. But non fatal complications were higher in those who had vacuum assisted debulking of vegetations along with lead extraction, compared to those who underwent only lead extraction. AngioVac system (Angio-Dynamics, Latham, NY, USA) was used in this study.

A systematic review of vacuum assisted lead vegetation removal along with lead extraction compiled data on 88 patients and 205 leads [2]. Lead extraction was successful 87 of the 88 patients. Vacuum extraction of vegetations were done in 81 patients along with lead extraction. There were no complications due to extraction of vegetations and there was no procedure related mortality. Four patients had major complications, two vascular injuries, one coronary sinus injury and one tricuspid valve injury.

In the past, those with large vegetations were referred for surgery. Now there is a percutaneous interventional option with high success rate and low complication rate [2].

References

  1. Soroosh Kiani, Dean Sabayon, Michael S Lloyd, Michael H Hoskins, Mikhael F El-Chami, Stacy Westerman, Ratna Vadlamudi, Brent Keeling, Omar M Lattouf, Faisal M Merchant. Outcomes of percutaneous vacuum-assisted debulking of large vegetations as an adjunct to lead extraction. Pacing Clin Electrophysiol. 2019 Jul;42(7):1032-1037.
  2. Akash Rusia, Audrey J Shi, Rahul N Doshi. Vacuum-assisted vegetation removal with percutaneous lead extraction: a systematic review of the literature. J Interv Card Electrophysiol. 2019 Aug;55(2):129-135.
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