Marinacci Lucas X, Sethi Sanjum S, Paras Molly L, El Sabbagh Abdallah, Secemsky Eric A, Sohail M Rizwan, Starck Christoph, Bearnot Benjamin, Yucel Evin, Schaerf Raymond H M, Akhtar Yasir, Younes Ahmad, Patton Marquand, Villablanca Pedro, Reddy Seenu, Enter Daniel, Moriarty John M, Keeling William Brent, El Hajj Younes Stephanie, Kiell Charles, Rosenfield Kenneth
Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Harvard Medical School, Boston, Massachusetts.
J Soc Cardiovasc Angiogr Interv. 2024 Nov 14;3(12):102283. doi: 10.1016/j.jscai.2024.102283. eCollection 2024 Dec.
The clinical presentation and epidemiology of infective endocarditis (IE) have evolved over time. While the cornerstones of IE treatment remain antimicrobial therapy and surgery, percutaneous mechanical aspiration (PMA) has emerged as an option for carefully selected patients as a complementary modality, based on retrospective data, case series, and expert experience. In this comprehensive review, we summarize the proceedings from an inaugural summit dedicated to the discussion of PMA in the global management of IE, consisting of experts across multiple disciplines from diverse geographic regions and care environments. After conceptualizing the 3 major roles of PMA as a bridge to decision, destination therapy, and adjunctive therapy, we then review the clinical scenarios in which PMA might be considered by IE subtype. We discuss patient selection, the rationale for intervention, and the most recent evidence for each. Next, we consider PMA for IE in the larger context of our health care system across 3 domains: clinical collaboration, financial considerations, and academic innovation, emphasizing the importance of interdisciplinary teams and cross-organizational partnerships, reimbursement models, and the need for high-quality research. Finally, we outline what we determined to be the most pressing outstanding questions in this space. In doing so, we propose a national consortium to help organize efforts to move this field forward and share our progress in these endeavors to date. PMA for IE has great promise, but significant work remains if we are to fully realize its potential to safely and effectively improve outcomes for modern endocarditis patients.
感染性心内膜炎（IE）的临床表现和流行病学随时间不断演变。虽然IE治疗的基石仍然是抗菌治疗和手术，但基于回顾性数据、病例系列和专家经验，经皮机械抽吸术（PMA）已成为精心挑选患者的一种选择，作为一种补充治疗方式。在这篇全面综述中，我们总结了首届峰会的会议记录，该峰会专门讨论PMA在IE全球管理中的应用，参会专家来自不同地理区域和医疗环境的多个学科。在将PMA的三个主要作用概念化为决策桥梁、目标治疗和辅助治疗后，我们接着回顾了根据IE亚型可能考虑采用PMA的临床情况。我们讨论了患者选择、干预理由以及各自的最新证据。接下来，我们在医疗保健系统的三个领域——临床协作、财务考量和学术创新的大背景下考虑IE的PMA，强调跨学科团队和跨组织伙伴关系、报销模式以及高质量研究的必要性的重要性。最后，我们概述了我们确定的该领域最紧迫的未决问题。在此过程中，我们提议成立一个全国性联盟，以帮助组织推动该领域发展的工作，并分享我们迄今为止在这些努力中的进展。IE的PMA前景广阔，但要充分实现其安全有效地改善现代心内膜炎患者预后的潜力，仍有大量工作要做。
