Gill Gauravpal S, Chakrala Teja, Kanmanthareddy Arun, Alla Venkata Mahesh
Division of Cardiovascular Disease, Creighton University School of Medicine, Omaha, NE, USA.
Department on Medicine, University of Florida, Gainesville, FL, USA.
Cardiovasc Revasc Med. 2023 Dec;57:8-15. doi: 10.1016/j.carrev.2023.06.006. Epub 2023 Jun 10.
Transcatheter aspiration is utilized for removal of thrombi and vegetations in inoperable patients and high-risk surgical candidates where medical therapy alone is unlikely to achieve desired outcome. A number of case reports and series have been published since the introduction of AngioVac system (AngioDynamics Inc., Latham, NY) in 2012 where this technology was used in the treatment of endocarditis. However, there is a lack of consolidated data reporting on patient selection, safety and outcomes.
PubMed and Google Scholar databases were queried for publications reporting cases where transcatheter aspiration was used for endocarditis vegetation debulking or removal. Data on patient characteristics, outcomes and complications from select reports were extracted and systematically reviewed.
Data from 11 publications with 232 patients were included in the final analyses. Of these, 124 had lead vegetation aspiration, 105 had valvular vegetation aspiration, and 3 had both lead as well as valvular vegetation aspiration. Among the 105 valvular endocarditis cases, 102 (97 %) patients had right sided vegetation removal. Patients with valvular endocarditis were younger (mean age 35 years) vs. patients with lead vegetations (mean age 66 years). Among the valvular endocarditis cases, there was a 50-85 % reduction in vegetation size, 14 % had worsening valvular regurgitation, 8 % had persistent bacteremia and 37 % required blood transfusion. Surgical valve repair or replacement was subsequently performed in 3 % and in-hospital mortality was 11 %. Among patients with lead infection, procedural success rate was reported at 86 %, 2 % had vascular complications and in-hospital mortality was 6 %. Persistent bacteremia, renal failure requiring hemodialysis, and clinically significant pulmonary embolism occurred in about 1 % each.
Transcatheter aspiration of vegetations in infective endocarditis has acceptable success rates in vegetation debulking as well as rates of morbidity or mortality. Large prospective multi-center studies are warranted to determine predictors of complications, thus helping identify suitable patients.
经导管抽吸术用于治疗无法手术的患者以及手术风险高的患者体内的血栓和赘生物，这些患者仅靠药物治疗不太可能达到预期效果。自2012年引入AngioVac系统（AngioDynamics公司，纽约州拉瑟姆）以来，已有多篇病例报告和系列研究发表，该技术被用于治疗心内膜炎。然而，目前缺乏关于患者选择、安全性和治疗结果的综合数据报告。
检索PubMed和谷歌学术数据库，查找报告经导管抽吸术用于清除心内膜炎赘生物的病例的出版物。从选定报告中提取有关患者特征、治疗结果和并发症的数据，并进行系统回顾。
最终分析纳入了11篇出版物中的232例患者的数据。其中，124例进行了导线赘生物抽吸，105例进行了瓣膜赘生物抽吸，3例同时进行了导线和瓣膜赘生物抽吸。在105例瓣膜性心内膜炎病例中，102例（97%）患者进行了右侧赘生物清除。瓣膜性心内膜炎患者比导线赘生物患者更年轻（平均年龄35岁 vs. 平均年龄66岁）。在瓣膜性心内膜炎病例中，赘生物大小减少了50%-85%，14%患者的瓣膜反流恶化，8%患者持续菌血症，37%患者需要输血。随后3%的患者进行了外科瓣膜修复或置换，住院死亡率为11%。在导线感染患者中，手术成功率报告为86%，2%患者出现血管并发症，住院死亡率为6%。持续菌血症、需要血液透析的肾衰竭和具有临床意义的肺栓塞的发生率均约为1%。
感染性心内膜炎赘生物的经导管抽吸术在清除赘生物方面成功率可接受，发病率和死亡率也在可接受范围内。有必要开展大型前瞻性多中心研究以确定并发症的预测因素，从而帮助识别合适的患者。
