1
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Wurcel AG, Suzuki J, Schranz AJ, Eaton EF, Cortes-Penfield N, Baddour LM. Strategies to Improve Patient-Centered Care for Drug Use-Associated Infective Endocarditis: JACC Focus Seminar 2/4. J Am Coll Cardiol 2024; 83:1338-1347. [PMID: 38569764 DOI: 10.1016/j.jacc.2024.01.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 04/05/2024]
Abstract
Drug use-associated infective endocarditis (DUA-IE) is a major cause of illness and death for people with substance use disorder (SUD). Investigations to date have largely focused on advancing the care of patients with DUA-IE and included drug use disorder treatment, decisions about surgery, and choice of antibiotics during the period of hospitalization. Transitions from hospital to outpatient care are relatively unstudied and frequently a key factor of uncontrolled infection, continued substance use, and death. In this paper, we review the evidence supporting cross-disciplinary care for people with DUA-IE and highlight domains that need further clinician, institutional, and research investment in clinicians and institutions. We highlight best practices for treating people with DUA-IE, with a focus on addressing health disparities, meeting health-related social needs, and policy changes that can support care for people with DUA-IE in the hospital and when transitioning to the community.
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Affiliation(s)
- Alysse G Wurcel
- Department of Medicine, Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts, USA.
| | - Joji Suzuki
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Asher J Schranz
- Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Ellen F Eaton
- Department of Medicine, University of Alabama, Birmingham, Alabama, USA
| | | | - Larry M Baddour
- Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
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2
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Bansal N, Younes S, Maaieh M. Percutaneous Debulking of a Large Mobile Mitral Valve Vegetation Using the Angiovac. Cureus 2024; 16:e56537. [PMID: 38646334 PMCID: PMC11027443 DOI: 10.7759/cureus.56537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2024] [Indexed: 04/23/2024] Open
Abstract
The Angiovac aspiration system has been used successfully for the removal of intravascular material or thrombus in the right-sided heart structures, vena cava, implantable cardiac defibrillator, or other devices. For infective endocarditis, it is reserved for the patients who warrant but are not good candidates for the surgery. The evidence regarding Angiovac aspiration of the infective endocarditis of the left-sided heart valves is scarce. The risk of complications, including thrombi fragmentation leading to systemic embolization, damage to the cardiac structures and tissue, and hemodynamic instability, precludes the widespread use of this procedure, especially for the left-sided lesions. We report a case of successful removal of the mitral valve endocarditis using the Angiovac aspiration technique under the TEE guidance. A SENTINEL™ cerebral protection system was used to prevent embolus migration and a venous rather than an arterial access was used for reperfusion.
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Affiliation(s)
- Nahush Bansal
- Department of Internal Medicine, The University of Toledo, Toledo, USA
| | - Stephanie Younes
- Department of Cardiology, ProMedica Toledo Hospital, Toledo, USA
| | - Mohammed Maaieh
- Department of Cardiology, ProMedica Toledo Hospital, Toledo, USA
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3
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Haddad SF, Lahr BD, El Sabbagh A, Wilson WR, Chesdachai S, DeSimone DC, Baddour LM. Percutaneous mechanical aspiration in patients with right-sided infective endocarditis: An analysis of the national inpatient sample database-2016-2020. Catheter Cardiovasc Interv 2024; 103:464-471. [PMID: 38287781 DOI: 10.1002/ccd.30958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 01/10/2024] [Accepted: 01/16/2024] [Indexed: 01/31/2024]
Abstract
BACKGROUND Given the challenges of conventional therapies in managing right-sided infective endocarditis (RSIE), percutaneous mechanical aspiration (PMA) of vegetations has emerged as a novel treatment option. Data on trends, characteristics, and outcomes of PMA, however, have largely been limited to case reports and case series. AIMS The aim of the current investigation was to provide a descriptive analysis of PMA in the United States and to profile the frequency of PMA with a temporal analysis and the patient cohort. METHODS The International Classification of Diseases, 10th Revision codes were used to identify patients with RSIE in the national (nationwide) inpatient sample (NIS) database between 2016 and 2020. The clinical characteristics and temporal trends of RSIE hospitalizations in patients who underwent PMA was profiled. RESULTS An estimated 117,955 RSIE-related hospital admissions in the United States over the 5-year study period were estimated and 1675 of them included PMA. Remarkably, the rate of PMA for RSIE increased 4.7-fold from 2016 (0.56%) to 2020 (2.62%). Patients identified with RSIE who had undergone PMA were young (medial age 36.5 years) and had few comorbid conditions (median Charlson Comorbidity Index, 0.6). Of note, 36.1% of patients had a history of hepatitis C infection, while only 9.9% of patients had a cardiovascular implantable electronic device. Staphylococcus aureus was the predominant (61.8%) pathogen. Concomitant transvenous lead extraction and cardiac valve surgery during the PMA hospitalization were performed in 18.2% and 8.4% of admissions, respectively. The median hospital stay was 19.0 days, with 6.0% in-hospital mortality. CONCLUSIONS The marked increase in the number of PMA procedures in the United States suggests that this novel treatment option has been embraced as a useful tool in select cases of RSIE. More work is needed to better define indications for the procedure and its efficacy and safety.
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Affiliation(s)
- Sara F Haddad
- Department of Medicine, Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, Minnesota, USA
| | - Brian D Lahr
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
| | - Abdallah El Sabbagh
- Department of Cardiovascular Disease, Mayo Clinic College of Medicine and Science, Mayo Clinic, Jacksonville, Florida, USA
| | - Walter R Wilson
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, Minnesota, USA
| | - Supavit Chesdachai
- Department of Medicine, Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel C DeSimone
- Department of Medicine, Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, Minnesota, USA
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, Minnesota, USA
| | - Larry M Baddour
- Department of Medicine, Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, Minnesota, USA
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, Minnesota, USA
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4
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Kim AG, Salazar AM, Panama G, Saeed M, Sabanci R, Al-Asad KS, Yavari M, Prasad RM, Rayamajhi S, Abela GS. Transcatheter Vacuum-Assisted Mass Extraction Versus Surgical Debridement for Vegetations in Tricuspid Valve Infective Endocarditis: A Meta-Analysis of Observational Studies. Am J Cardiol 2024; 210:69-75. [PMID: 37839690 DOI: 10.1016/j.amjcard.2023.10.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/26/2023] [Accepted: 10/05/2023] [Indexed: 10/17/2023]
Abstract
Tricuspid valve infective endocarditis (TVIE), often associated with vegetation in people who inject drugs, has introduced a less invasive option for vegetation removal: transcatheter vacuum-assisted mass extraction (TVME). This technique is emerging as an alternative to standard surgical debridement (SD) and valve repair. However, the comparative effectiveness of TVME versus SD in treating TVIE has yet to be investigated. A comprehensive systematic literature search was performed on PubMed, Embase, and Cochrane to identify all relevant studies comparing TVME with SD in patients with TVIE. The search covered studies from inception up to August 15, 2023. For data analysis, Review Manager (RevMan) 5.4 software was employed, using a random-effects model to calculate risk ratios (RRs), mean differences, and 95% confidence intervals (CIs). Five studies included a total of 431 patients (244 in the TVME arm and 187 in the SD arm). In-hospital mortality (p = 0.72), procedural mortality (p = 0.77), 30-day mortality (p = 0.25), and 1-year mortality (p = 0.44) insignificantly favored SD over TVME. Overall mortality across the 5 studies insignificantly favored TVME over SD (RR = 0.66, 95% CI 0.31 to 1.39, p = 0.27, I2 = 57%). When addressing heterogeneity by excluding 1 study, no statistical significance in the difference between the 2 arms regarding overall mortality was observed (RR 0.99, 95% CI 0.60 to 1.63, p = 0.97, I2 = 0%). This meta-analysis of the 5 observational studies found no significant difference in overall mortality between TVME and SD for the treatment of TVIE. However, prospective randomized controlled trials are necessary to further understand and compare the outcomes of these 2 approaches.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - George S Abela
- Cardiology, Michigan State University, East Lansing, Michigan
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5
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Mourad A, Hillenbrand M, Skalla LA, Holland TL, Zwischenberger BA, Williams AR, Turner NA. Scoping review of percutaneous mechanical aspiration for valvular and cardiac implantable electronic device infective endocarditis. Clin Microbiol Infect 2023; 29:1508-1515. [PMID: 37634864 DOI: 10.1016/j.cmi.2023.08.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/15/2023] [Accepted: 08/20/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND Percutaneous mechanical aspiration (PMA) of intravascular vegetations is a novel strategy for management of patients with infective endocarditis (IE) who are at high risk of poor outcomes with conventional cardiac surgery. However, clear indications for its use as well as patient outcomes are largely unknown. OBJECTIVES To conduct a scoping review of the literature to summarize patient characteristics and outcomes of those undergoing PMA for management of IE. METHODS Two independent reviewers screened abstracts and full text for inclusion and independently extracted data. DATA SOURCES MEDLINE, Embase, and Web of Science. STUDY ELIGIBILITY CRITERIA Studies published until February 21, 2023, describing the use of PMA for management of patients with cardiac implantable electronic device (CIED) or valvular IE were included. ASSESSMENT OF RISK OF BIAS As this was a scoping review, risk of bias assessment was not performed. METHODS OF DATA SYNTHESIS Descriptive data was reported. RESULTS We identified 2252 titles, of which 1442 abstracts were screened, and 125 full text articles were reviewed for inclusion. Fifty-one studies, describing a total of 294 patients who underwent PMA for IE were included in our review. Over 50% (152/294) of patients underwent PMA to debulk cardiac implantable electronic device lead vegetations prior to extraction (152/294), and 38.8% (114/294) of patients had a history of drug use. Patient outcomes were inconsistently reported, but few had procedural complications, and all-cause in-hospital mortality was 6.5% (19/294). CONCLUSIONS While PMA is a promising advance in the care of patients with IE, higher quality data regarding patient outcomes are needed to better inform the use of this procedure.
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Affiliation(s)
- Ahmad Mourad
- Department of Medicine, Division of Infectious Diseases, Duke University Medical Center, Durham, NC, USA
| | - Molly Hillenbrand
- Department of Medicine, Division of Infectious Diseases, Duke University Medical Center, Durham, NC, USA
| | - Lesley A Skalla
- Duke University Medical Center Library & Archives, Duke University School of Medicine, Durham, NC, USA
| | - Thomas L Holland
- Department of Medicine, Division of Infectious Diseases, Duke University Medical Center, Durham, NC, USA
| | - Brittany A Zwischenberger
- Department of Surgery, Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Adam R Williams
- Department of Surgery, Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Nicholas A Turner
- Department of Medicine, Division of Infectious Diseases, Duke University Medical Center, Durham, NC, USA.
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6
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Gill GS, Chakrala T, Kanmanthareddy A, Alla VM. Transcatheter vacuum aspiration of valvular and lead related infective endocarditis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 57:8-15. [PMID: 37331887 DOI: 10.1016/j.carrev.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Gauravpal S Gill
- Division of Cardiovascular Disease, Creighton University School of Medicine, Omaha, NE, USA
| | - Teja Chakrala
- Department on Medicine, University of Florida, Gainesville, FL, USA
| | - Arun Kanmanthareddy
- Division of Cardiovascular Disease, Creighton University School of Medicine, Omaha, NE, USA
| | - Venkata Mahesh Alla
- Division of Cardiovascular Disease, Creighton University School of Medicine, Omaha, NE, USA.
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7
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Thompson L, Alkhayru A, Ahmad U, Hughes J, Ebrahimi A, Degheim G, Jabbar AA. Novel Use of the Penumbra CAT 12 Lightning Aspiration System for the Treatment of a Complex Thrombus. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 53S:S271-S275. [PMID: 35725691 DOI: 10.1016/j.carrev.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/06/2022] [Accepted: 06/06/2022] [Indexed: 11/24/2022]
Abstract
Debulking procedures using aspiration devices have been previously described in the literature to treat vegetations or thrombi on intracardiac structures such as the tricuspid valve. Transcatheter therapy has also been shown to be an effective alternative to surgical treatment for managing high risk or non-surgical patients. Furthermore, aspiration procedures can help identify the unique etiologies of intracardiac masses which can greatly impact differing treatment modalities. Utilization of aspiration devices combined with blood-loss limiting technologies have led to an increased interest in using aspiration systems to address a wider array of clinical situations that can occur. Herein we describe our experience in using the Penumbra CAT 12 Lightning Aspiration System in addressing and treating a mobile mass attached to the lead of an implantable cardiac device.
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Affiliation(s)
- Luke Thompson
- HCA Healthcare GME at Northside Hospital, USF Morsani College of Medicine, The Heart Institute, St. Petersburg, FL, United States of America
| | - Ali Alkhayru
- HCA Healthcare GME at Northside Hospital, USF Morsani College of Medicine, The Heart Institute, St. Petersburg, FL, United States of America
| | - Usman Ahmad
- HCA Healthcare GME at Northside Hospital, USF Morsani College of Medicine, The Heart Institute, St. Petersburg, FL, United States of America
| | - John Hughes
- HCA Healthcare GME at Northside Hospital, USF Morsani College of Medicine, The Heart Institute, St. Petersburg, FL, United States of America
| | - Ali Ebrahimi
- HCA Healthcare GME at Northside Hospital, USF Morsani College of Medicine, The Heart Institute, St. Petersburg, FL, United States of America; University of Alabama at Birmingham, Department of Cardiovascular Disease, Birmingham, AL, United States of America
| | - George Degheim
- HCA Healthcare GME at Northside Hospital, USF Morsani College of Medicine, The Heart Institute, St. Petersburg, FL, United States of America
| | - Ali Abdul Jabbar
- HCA Healthcare GME at Northside Hospital, USF Morsani College of Medicine, The Heart Institute, St. Petersburg, FL, United States of America.
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8
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Siddiqui E, Alviar CL, Ramachandran A, Flattery E, Bernard S, Xia Y, Nayar A, Keller N, Bangalore S. Outcomes After Tricuspid Valve Operations in Patients With Drug-Use Infective Endocarditis. Am J Cardiol 2022; 185:80-86. [DOI: 10.1016/j.amjcard.2022.08.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/18/2022] [Accepted: 08/25/2022] [Indexed: 11/01/2022]
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9
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Di Mauro M, Bonalumi G, Giambuzzi I, Dato GMA, Centofanti P, Corte AD, Ratta ED, Cugola D, Merlo M, Santini F, Salsano A, Rinaldi M, Mancuso S, Cappabianca G, Beghi C, De Vincentiis C, Biondi A, Livi U, Sponga S, Pacini D, Murana G, Scrofani R, Antona C, Cagnoni G, Nicolini F, Benassi F, De Bonis M, Pozzoli A, Pano M, Nicolardi S, Falcetta G, Colli A, Musumeci F, Gherli R, Vizzardi E, Salvador L, Picichè M, Paparella D, Margari V, Troise G, Villa E, Dossena Y, Lucarelli C, Onorati F, Faggian G, Mariscalco G, Maselli D, Barili F, Parolari A, Lorusso R. Similar outcome of tricuspid valve repair and replacement for isolated tricuspid infective endocarditis. J Cardiovasc Med (Hagerstown) 2022; 23:406-413. [PMID: 35645032 DOI: 10.2459/jcm.0000000000001310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS To compare early and late mortality of acute isolated tricuspid valve infective endocarditis (TVIE) treated with valve repair or replacement. METHODS Patients who were surgically treated for TVIE from 1983 to 2018 were retrieved from the Italian Registry for Surgical Treatment of Valve and Prosthesis Infective Endocarditis. All the patients were followed up by means of phone interview or calling patient referral physicians or cardiologists. Kaplan-Meier method was used to assess late survival and survival free from TVIE recurrence with log-rank test for univariate comparison. The primary end points were early mortality (30 days after surgery) and long-term survival free from TVIE recurrence. RESULTS A total of 4084 patients were included in the registry. Among them, 149 patients were included in the study. Overall, 77 (51.7%) underwent TV repair and 72 (48.3%) TV replacement. Early mortality was 9% (13 patients). Expected early mortality according to EndoSCORE was 12%. The TV repair showed lower mortality and major complication rate (7% and 16%), compared with TV replacement (11% and 25%), but statistical significance was not reached. Median follow-up was 19.1 years (14.3-23.8). Late deaths were 30 and IE recurrences were 5. No difference in cardiac survival free from IE was found between the two groups after 20 years (80 ± 6% Repair Group vs 59 ± 13% Replacement Group, P = 0.3). CONCLUSIONS Overall results indicate that once surgically addressed, TVIE has a low recurrence rate and excellent survival, apparently regardless of the type of surgery used to treat it.
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Affiliation(s)
- Michele Di Mauro
- Cardio-Thoracic Surgery Department, Heart & Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | | | | | | | | | | | - Diego Cugola
- Cardiac Surgery, AO Papa Giovanni XXIII, Bergamo
| | | | | | - Antonio Salsano
- Cardiac Surgery, IRCCS San Martino-IST, University Hospital, Genova
| | - Mauro Rinaldi
- Cardiac Surgery, Molinette Hospital, University of Turin, Turin
| | - Samuel Mancuso
- Cardiac Surgery, Molinette Hospital, University of Turin, Turin
| | | | | | | | - Andrea Biondi
- Cardiac Surgery, San Donato IRCCS Hospital, San Donato Milanese, Milan
| | - Ugolino Livi
- Cardiac Surgery, S. Maria Misericordia Hospital, University of Udine, Udine
| | - Sandro Sponga
- Cardiac Surgery, S. Maria Misericordia Hospital, University of Udine, Udine
| | - Davide Pacini
- Cardiac Surgery, S. Orsola-Malpighi University Hospital, University of Bologna, Bologna
| | - Giacomo Murana
- Cardiac Surgery, S. Orsola-Malpighi University Hospital, University of Bologna, Bologna
| | | | - Carlo Antona
- Cardiac Surgery, Sacco Hospital, University of Milan, Milan
| | | | - Francesco Nicolini
- Cardiac Surgery, Maggiore University Hospital, University of Parma, Parma
| | - Filippo Benassi
- Cardiac Surgery, Maggiore University Hospital, University of Parma, Parma
| | | | | | - Marco Pano
- Cardiac Surgery, Vito Fazi Hospital, Lecce
| | | | - Giosuè Falcetta
- Cardiac Surgery, AO Pisana University Hospital, University of Pisa, Pisa
| | - Andrea Colli
- Cardiac Surgery, AO Pisana University Hospital, University of Pisa, Pisa
| | | | | | | | | | | | | | | | | | | | | | - Carla Lucarelli
- Cardiac Surgery, University Hospital, University of Verona, Verona, Italy
| | - Francesco Onorati
- Cardiac Surgery, University Hospital, University of Verona, Verona, Italy
| | - Giuseppe Faggian
- Cardiac Surgery, University Hospital, University of Verona, Verona, Italy
| | | | | | | | - Alessandro Parolari
- Department of Universitary Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese.,Department of Biomedical Sciences for Health, Università di Milano, Milan, Italy
| | - Roberto Lorusso
- Cardio-Thoracic Surgery Department, Heart & Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
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10
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Akhtar YN, Barry Iv N, Foster MT, Adigun S, Smith G, Walker WA, Weiman DS. Case Series of Percutaneous Mechanical Aspiration of Mitral Valve Endocarditis. JACC Case Rep 2022; 4:523-528. [PMID: 35573849 PMCID: PMC9091537 DOI: 10.1016/j.jaccas.2022.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 02/07/2022] [Accepted: 02/22/2022] [Indexed: 11/12/2022]
Abstract
Infective endocarditis of the mitral valve that is refractory to medical therapy requires surgical debridement. However, patients who are high risk for surgery have limited options. We report 3 cases of refractory infective endocarditis involving the mitral valve that were treated with percutaneous mechanical aspiration with an embolic protection system. (Level of Difficulty: Intermediate.)
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Affiliation(s)
- Yasir N Akhtar
- Division of Cardiology, Tennova Heart Institute, Knoxville, Tennessee, USA
| | - Neil Barry Iv
- Division of Cardiology, Tennova Heart Institute, Knoxville, Tennessee, USA
| | - Malcolm T Foster
- Division of Cardiology, Tennova Heart Institute, Knoxville, Tennessee, USA
| | - Shade Adigun
- Division of Cardiology, Tennova Heart Institute, Knoxville, Tennessee, USA
| | - Gary Smith
- Division of Cardiology, Tennova Heart Institute, Knoxville, Tennessee, USA
| | - William A Walker
- Division of Cardiothoracic Surgery, Tennova Heart Institute, Knoxville, Tennessee, USA
| | - Darryl S Weiman
- Division of Cardiothoracic Surgery, Tennova Heart Institute, Knoxville, Tennessee, USA
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11
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Abstract
The management of infective endocarditis is complex and inherently requires multidisciplinary cooperation. About half of all patients diagnosed with infective endocarditis will meet the criteria to undergo cardiac surgery, which regularly takes place in urgent or emergency settings. The pathophysiology and clinical presentation of infective endocarditis make it a unique disorder within cardiac surgery that warrants a thorough understanding of specific characteristics in the perioperative period. This includes, among others, echocardiography, coagulation, bleeding management, or treatment of organ dysfunction. In this narrative review article, the authors summarize the current knowledge on infective endocarditis relevant for the clinical anesthesiologist in perioperative management of respective patients. Furthermore, the authors advocate for the anesthesiologist to become a structural member of the endocarditis team.
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12
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Akhtar YN, Walker WA, Shakur U, Smith G, Husnain SS, Adigun SF. Clinical outcomes of percutaneous debulking of tricuspid valve endocarditis in intravenous drug users. Catheter Cardiovasc Interv 2021; 97:1290-1295. [PMID: 33645916 DOI: 10.1002/ccd.29584] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 01/22/2021] [Accepted: 02/14/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVES A retrospective case series of a percutaneous approach to debulk tricuspid valve endocarditis (TVE) using an 8 French mechanical aspiration system in patients with a history of intravenous drug use (IVDU) was reported. IVDU associated TVE is increasing in the United States and is associated with high mortality despite early surgical debridement. Patients with advanced disease, shock, and respiratory failure may not be candidates for surgical debridement or replacement. These patients have recurrent events despite medical therapy METHODS: About 25 patients with IVDU associated TVE with persistent bacteremia confirmed by repeat blood cultures after 72 hr of sensitivity directed antibiotics and presence of pulmonary emboli confirmed by computed tomographic (CT) scan, who had undergone percutaneous aspiration were included. Patients were all deemed high risk for surgical debridement by a CT surgeon and evaluated by an infectious disease consultant. Procedures were performed under moderate sedation with intracardiac echo and a steerable guide with a CAT8 Penumbra aspiration catheter. RESULTS There were no intraprocedural deaths or complications. About 36% had septic shock on presentation. Survival of index hospitalization was 88%. Repeat blood cultures showed no growth on all surviving patients. Readmission rate was 4% (n = 1) at 1 month. About 40% (n = 2) patients with septic shock survived at 1 month compared with 100% survival (n = 20) in those without shock. Presence of septic shock was associated with reduced survival at 1 month (p < .01). CONCLUSION Percutaneous mechanical aspiration with an 8 Fr system is a feasible, minimally invasive alternative to surgical debulking. Mortality remains high in those presenting with septic shock. Further studies are needed to evaluate long-term outcomes.
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Affiliation(s)
- Yasir N Akhtar
- Tennova Healthcare, Turkey Creek Medical Center, Knoxville, Tennessee, US
| | - William A Walker
- Tennova Healthcare, Turkey Creek Medical Center, Knoxville, Tennessee, US
| | - Umar Shakur
- Sturdy Memorial Hospital, Attleboro, Massachusetts, US
| | - Gary Smith
- Tennova Healthcare, Turkey Creek Medical Center, Knoxville, Tennessee, US
| | - Syed S Husnain
- Tennova Healthcare, Turkey Creek Medical Center, Knoxville, Tennessee, US
| | - Shade F Adigun
- Tennova Healthcare, Turkey Creek Medical Center, Knoxville, Tennessee, US
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Bangalore S, Alviar CL, Vlahakis S, Keller N. Tricuspid valve vegetation debulking using the AngioVac system. Catheter Cardiovasc Interv 2021; 98:E475-E477. [PMID: 33565679 DOI: 10.1002/ccd.29519] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/28/2020] [Accepted: 01/15/2021] [Indexed: 12/12/2022]
Abstract
Tricuspid valve endocarditis with recurrent septic pulmonary emboli is an indication for surgery. We present the case of a 36-year old man with tricuspid valve endocarditis and septic pulmonary emboli with percutaneous extraction of the vegetation. We discuss the nuances of such an approach and the need for more evidence in the management of these complex patients.
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Affiliation(s)
- Sripal Bangalore
- Grossman School of Medicine, New York University, New York, New York
| | - Carlos L Alviar
- Grossman School of Medicine, New York University, New York, New York
| | - Susan Vlahakis
- Grossman School of Medicine, New York University, New York, New York
| | - Norma Keller
- Grossman School of Medicine, New York University, New York, New York
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