Reddy V Seenu, Zwischenberger Brittany A, Williams Adam R, Rowe Joseph F, Subramanian Sreekumar, Kingeter Adam, Wright Justin, Joseph Mark
Division of Cardiothoracic Surgery, TriStar Centennial Medical Center, HCA Healthcare, Nashville, Tennessee.
Department of Surgery, Duke University Medical Center, Durham, North Carolina.
Ann Thorac Surg Short Rep. 2024 Apr 26;2(4):748-753. doi: 10.1016/j.atssr.2024.03.012. eCollection 2024 Dec.
Undergoing an urgent valve surgical procedure to treat patients with tricuspid valve endocarditis carries a high risk of operative morbidity and mortality. Use of a percutaneous vacuum-assisted system to treat tricuspid valve endocarditis is an alternative to surgical procedures.
This study retrospectively analyzed data from 187 transcatheter vacuum-assisted aspiration procedures performed in 177 patients with tricuspid valve vegetations at 3 different centers between 2017 and April 2022. The device was deployed through the internal jugular or femoral vein into the right atrium by using transesophageal echocardiography and fluoroscopy guidance with the return cannula placed in the femoral vein. The following data were analyzed: intravascular material aspirated, collected in an external filter, and cultured; hospital length of stay; procedural complications; blood culture clearance; and tricuspid regurgitation.
The mean age of participants was 35.5 ± 10.8 years (range, 18-79 years). A total of 107 procedures (57.2%) were performed in female patients, and 163 (87.2%) procedures were performed in intravenous drug users. All patients survived the procedure, and there were no procedural complications. The average length of stay was 26.8 ± 18.5 days (range, 1-96 days). Most preoperative positive blood cultures showed (80.3%), with postoperative cultures converting to negative in 103 (70.1%) of 147 procedures. Tricuspid regurgitation remained unchanged after 95 (50.8%) procedures and worsened after 40 (21.4%) procedures.
Percutaneous vacuum-assisted aspiration system provides a safe alternative to urgent tricuspid valve surgical procedures for removal of vegetations, especially in patients with endocarditis. Initial vegetation debulking can expedite clearance of blood cultures while avoiding major cardiac surgery operations and implantation of prosthetic valves in these high-risk patients.
对三尖瓣心内膜炎患者进行紧急瓣膜手术治疗，手术 morbidity 和 mortality 风险很高。使用经皮真空辅助系统治疗三尖瓣心内膜炎是手术治疗的一种替代方法。
本研究回顾性分析了 2017 年至 2022 年 4 月期间在 3 个不同中心对 177 例有三尖瓣赘生物的患者进行的 187 例经导管真空辅助抽吸手术的数据。通过经食管超声心动图和荧光透视引导，将该装置经颈内静脉或股静脉置入右心房，回流套管置于股静脉。分析了以下数据：血管内吸出物、收集在外部过滤器中并进行培养；住院时间；手术并发症；血培养转阴情况；以及三尖瓣反流。
参与者的平均年龄为 35.5±10.8 岁（范围 18 - 79 岁）。女性患者共进行了 107 例手术（57.2%），静脉吸毒者进行了 163 例手术（87.2%）。所有患者手术存活，无手术并发症。平均住院时间为 26.8±18.5 天（范围 1 - 96 天）。大多数术前血培养阳性（80.3%），147 例手术中有 103 例（70.1%）术后培养转阴。95 例手术（50.8%）后三尖瓣反流无变化，40 例手术（21.4%）后三尖瓣反流加重。
经皮真空辅助抽吸系统为紧急三尖瓣手术切除赘生物提供了一种安全的替代方法，特别是对于心内膜炎患者。最初的赘生物减容可以加快血培养转阴，同时避免在这些高危患者中进行心脏大手术和植入人工瓣膜。
