Department of Cardiology, Tulane University Medical Center, 1430 Tulane Ave, New Orleans, LA, 70112, USA.
Department of Cardiology, Lankenau Medical Center, Wynnewood, PA, USA.
Curr Cardiol Rep. 2023 Jul;25(7):681-691. doi: 10.1007/s11886-023-01891-w. Epub 2023 May 11.
The clinical guidelines and current practice in the field of removable cardiovascular pathologies are not aligned and are in fluctuation. The purpose of this review manuscript is to propose adjustments and forecast changes in clinical practice in this field ahead of irrefutable evidence. Percutaneous aspiration devices may be used in case of pulmonary embolism, endocarditis, cardiac thrombi, and tumors. The rationale of treatment includes prevention of emboli, endocarditis debulking and modification, sampling of tissue, and salvage therapy. We are describing the contemporary treatments that are occurring in practice outside and above guidelines.
The current standard therapy for the above-mentioned entities is not supported by robust data. Moreover, evidence suggesting priority for the use of percutaneous aspiration devices as first-line therapy-before turning to or in lieu of surgery or thrombolysis-continues to accumulate. However, guidelines still mention percutaneous aspiration only as an alternative to standard treatment. In the current review, we discuss the pathophysiology that supports percutaneous cardiac and pulmonary artery aspiration, the commonly used devices for that purpose, their clinical evidence, and accordingly propose a modified approach to patient management. In addition, this review highlights fluid dynamic principles important in matter extraction in order to better define the utility of catheter-based technologies in different cardiovascular territories. The target diseases encompassed in this review are pulmonary embolism, cardiac masses, and vegetations.
目的：可移除心血管病变领域的临床指南和当前实践并不一致，且处于变化之中。本文的目的是在无可争议的证据出现之前，提出该领域临床实践的调整和预测变化。在发生肺栓塞、心内膜炎、心脏血栓和肿瘤时，可使用经皮抽吸装置。治疗的基本原理包括预防栓塞、心内膜炎的清除和修饰、组织取样和挽救治疗。我们正在描述实践中正在发生的、超出指南范围的当代治疗方法。
新发现：目前上述疾病的标准治疗方法并没有得到确凿数据的支持。此外，越来越多的证据表明，在转向手术或溶栓治疗之前，或替代手术或溶栓治疗，优先使用经皮抽吸装置作为一线治疗方法。然而，指南仍仅将经皮抽吸装置作为标准治疗的替代方法提及。在本次综述中，我们讨论了支持经皮心内和肺动脉抽吸的病理生理学、为此目的常用的装置、它们的临床证据，并相应地提出了一种改良的患者管理方法。此外，本综述强调了在物质提取中重要的流体动力学原理，以便更好地定义基于导管的技术在不同心血管区域的应用。本文综述涵盖的目标疾病包括肺栓塞、心脏肿块和赘生物。
