Riasat Maria, Hanumanthu Balaram Krishna J, Khan Arshan, Haseeb Riaz Abdul, Anjum Zauraiz, Ehtesham Moiz, Ur Rehman Saif, Javed Ayesha, Muhammad Abdullah, Misra Deepika
Department of Internal Medicine, Mount Sinai Beth Israel, Manhattan, NY, United States.
Department of Cardiology, Mount Sinai Beth Israel, Manhattan, NY, United States.
Int J Cardiol Heart Vasc. 2023 Jun 12;47:101231. doi: 10.1016/j.ijcha.2023.101231. eCollection 2023 Aug.
AngioVac is used for the percutaneous removal of vegetations and for debulking of large vegetations in patients who are not surgical candidates.This study aims to identify the demographics, echocardiographic features, indications, improvement of the tricuspid valve regurgitation, and survival outcomes of patients who have undergone AngioVac vegetectomy reported in the literature.
A systematic review was performed to identify articles reporting suction thromectomy or vegetation removal using the AngioVac system for RSIE (right sided infective endocarditis). Survival on discharge was our primary outcome. Additionally, we evaluated indications for suction thrombectomy and TR improvement. Categorical variables were expressed as percentages and ratios.
A total of 49 studies were identified. The most common risk factor was intravenous drug abuse seen in 45% (20/49) and cardiovascular implantable electronic device (CIED) in 45% (20/49). Circulatory shock was seen in 35% of patients. The causative organism was gram positive cocci (86%). Moderate to severe TR was present in 74% of cases with documented echocardiograms. Indications for AngioVac were poor surgical candidacy (81%) or to reduce septic emboli risk (19%). Survival at discharge was 93%. TR improvement was reported only in 16% cases and remained unchanged/worsened in 84%.
AngioVac procedure is an alternative treatment for critically ill patients who cannot undergo surgery. To understand the survival, safety and candidacy of patients undergoing this procedure, further randomized control studies and literature reviews are needed. The improvement or worsening of tricuspid regurgitation in patients with TR valve involvement is another factor to be investigated.
AngioVac用于经皮清除赘生物，以及在不适合手术的患者中清除大型赘生物。本研究旨在确定文献中报道的接受AngioVac赘生物切除术患者的人口统计学特征、超声心动图特征、适应症、三尖瓣反流的改善情况以及生存结局。
进行了一项系统评价，以确定报告使用AngioVac系统进行抽吸血栓切除术或清除赘生物治疗右侧感染性心内膜炎（RSIE）的文章。出院时的生存率是我们的主要结局。此外，我们评估了抽吸血栓切除术的适应症和三尖瓣反流的改善情况。分类变量以百分比和比率表示。
共确定了49项研究。最常见的危险因素是静脉药物滥用，见于45%（20/49）的患者，心血管植入式电子设备（CIED）见于45%（20/49）的患者。35%的患者出现循环休克。病原体为革兰氏阳性球菌（86%）。在有记录的超声心动图病例中，74%存在中度至重度三尖瓣反流。AngioVac的适应症为手术候选性差（81%）或降低脓毒性栓子风险（19%）。出院时的生存率为93%。仅16%的病例报告三尖瓣反流有所改善，84%保持不变或恶化。
AngioVac手术是无法接受手术的重症患者的一种替代治疗方法。为了解接受该手术患者的生存情况、安全性和候选性，需要进一步的随机对照研究和文献综述。三尖瓣受累患者三尖瓣反流的改善或恶化是另一个需要研究的因素。
