Division of Cardiovascular and Structural Heart Disease, Lankenau Medical Center and Lankenau Institute of Medical Research, Wynnewood, Pennsylvania, USA.
Division of Cardiothoracic Surgery, Lankenau Medical Center and Lankenau Institute of Medical Research, Wynnewood, Pennsylvania, USA.
Catheter Cardiovasc Interv. 2022 Oct;100(4):667-673. doi: 10.1002/ccd.30319. Epub 2022 Jul 30.
Vacuum assisted aspiration with the AngioVac system has been well described for; right sided endocarditis, venous thrombus, lead related infection/thrombus aspiration and right sided cardiac mass evacuation. Percutaneous transeptal debulking with AngioVac for mitral valve endocarditis (MVE) in the inoperable or high surgical risk patient has not been well defined. A significant proportion of high/prohibitive surgical risk patients with left sided infective endocarditis (IE) are not offered valve surgery as patients in the acute active phase of IE have a high surgical mortality. Nonetheless, sequala of acute IE ie stroke, sepsis or hemodynamic instability in itself is associated with high morbidity and mortality without surgical treatment. A case report of an inoperable patient with methicillin sensitive staphylococcus aureus MVE who was offered MV vegetation debulking with the AngioVac Gen3 C 180 MV system is described. Preprocedural planning with attention to; optimal transeptal height puncture, use of sentinel cerebral protection device to decrease risk of procedure related cerebral embolism and venous extracorporeal membrane cannula, rather than arterial cannula for reinfusion, is described to avoid large bore arterial access related vascular complications. Further studies in a randomized manner are warranted to test these procedural techniques and determine outcomes of percutaneous aspiration of left sided IE with the AngioVac system in this highrisk inoperable cohort of patients.
血管真空抽吸系统（AngioVac）已广泛应用于：右侧心内膜炎、静脉血栓、导丝相关感染/血栓抽吸、右侧心脏肿块清除。对于无法手术或手术风险高的二尖瓣心内膜炎（MVE）患者，经皮房间隔切开术并用 AngioVac 进行二尖瓣瓣叶赘生物清除术尚未得到充分定义。很大一部分左心感染性心内膜炎（IE）的高/禁忌手术风险患者并未接受瓣膜手术，因为 IE 急性活动期的患者手术死亡率很高。然而，IE 的后遗症，如中风、败血症或血流动力学不稳定，本身就与高发病率和死亡率相关，如果不进行手术治疗。本文报告了 1 例无法手术的耐甲氧西林金黄色葡萄球菌（MSSA）MVE 患者，使用 AngioVac Gen3 C 180 MV 系统进行 MV 赘生物清除术。术前计划应注意：最佳房间隔穿刺高度、使用监测脑保护装置降低与手术相关的脑栓塞风险、使用静脉体外膜氧合管，而非动脉管用于再灌注，以避免大口径动脉通路相关血管并发症。需要进一步进行随机研究来验证这些手术技术，并确定 AngioVac 系统在该高风险无法手术患者人群中经皮抽吸治疗左心 IE 的结果。
