Mullins Jared B, Warner Alexander, Patel Vijay S, Arora Vishal
Division of Cardiology, Department of Medicine, Medical College of Georgia, Augusta University, Augusta, Georgia.
Division of General Internal Medicine, Department of Medicine, Medical College of Georgia, Augusta University, Augusta, Georgia.
J Soc Cardiovasc Angiogr Interv. 2024 Apr 16;3(6):101979. doi: 10.1016/j.jscai.2024.101979. eCollection 2024 Jun.
The AngioVac system is a vacuum aspiration device approved for removal of right-sided cardiac thrombi. It has also been used for management of right-sided endocarditis in selected cases. Retrospective case series have reported high success rate and acceptable 30-day mortality, but there is limited data regarding outcomes beyond the immediate postoperative period. The purpose of this study is to describe our institution's experience with the AngioVac system for thrombus, vegetation, and tumor removal with a significant improvement over previously reported 1-year survival rates.
A retrospective review of AngioVac cases performed at our tertiary care center from 2016-2022 was done. From 2016-2022, 23 patients were identified, and their outcomes are described.
Our review demonstrates 81.8% procedural success, 100% procedure survival, 90.9% survival to discharge, and 81.8% 30-day survival rates. One-year survival rate was 72.7%. Complications including an 18.2% rate of new vasopressor use, 54.5% rate of transfusion requirement, and 4.5% rate of acute renal failure requiring hemodialysis were identified. Intraprocedural embolization occurred in 1 case requiring venoarterial extracorporeal membrane oxygenation support and thrombectomy. One case was converted to open surgical intervention.
Our review further supports the safety and efficacy of minimally invasive vacuum-assisted aspiration systems beyond the immediate postoperative period in intracardiac thrombus, tumor, and right-sided infective endocarditis. Our institution's experience emphasizes a team-based approach including interventional cardiology and cardiothoracic surgery with a standardized imaging approach with transesophageal echocardiogram. Future guidelines are needed to include an algorithmic approach to intracardiac masses.
AngioVac系统是一种经批准用于清除右侧心脏血栓的真空抽吸装置。在某些特定病例中，它也被用于治疗右侧心内膜炎。回顾性病例系列报道了该系统具有较高的成功率和可接受的30天死亡率，但关于术后近期以外的结局数据有限。本研究的目的是描述我们机构使用AngioVac系统清除血栓、赘生物和肿瘤的经验，其1年生存率较先前报道有显著提高。
对2016年至2022年在我们三级医疗中心进行的AngioVac病例进行回顾性分析。2016年至2022年期间，共确定了23例患者，并描述了他们的结局。
我们的回顾显示，手术成功率为81.8%，手术生存率为100%，出院生存率为90.9%，30天生存率为81.8%。1年生存率为72.7%。确定的并发症包括18.2%的新用血管升压药率、54.5%的输血需求率和4.5%的需要血液透析的急性肾衰竭率。术中发生1例栓塞，需要静脉-动脉体外膜肺氧合支持和血栓切除术。1例转为开放手术干预。
我们的回顾进一步支持了微创真空辅助抽吸系统在心脏内血栓、肿瘤和右侧感染性心内膜炎术后近期以外的安全性和有效性。我们机构的经验强调了一种基于团队的方法，包括介入心脏病学和心胸外科，并采用经食管超声心动图的标准化成像方法。未来的指南需要纳入一种针对心脏内肿块的算法方法。
