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Ortoleva J, Shapeton AD, Riley W, Karavas A. Surgical and Transcatheter Approaches to Tricuspid Valve Endocarditis: Much to Consider. J Cardiothorac Vasc Anesth 2024; 38:868-870. [PMID: 38350742 DOI: 10.1053/j.jvca.2024.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 01/19/2024] [Indexed: 02/15/2024]
Affiliation(s)
- Jamel Ortoleva
- Department of Anesthesiology, Boston Medical Center, Boston, MA.
| | - Alexander D Shapeton
- Veterans Affairs Boston Healthcare System, Department of Anesthesia, Critical Care and Pain Medicine, and Tufts University School of Medicine, Boston, MA
| | - William Riley
- Department of Perfusion, Boston Medical Center, Boston, MA
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2
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Kucuk HO, Nan JZ, Larson KF, Sinak LJ, Eleid MF. Percutaneous Vacuum-Assisted Aspiration of Mobile Caseous Mitral Annulus Calcification. JACC Case Rep 2024; 29:102182. [PMID: 38361568 PMCID: PMC10865118 DOI: 10.1016/j.jaccas.2023.102182] [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: 11/21/2023] [Accepted: 12/01/2023] [Indexed: 02/17/2024]
Abstract
A 68-year-old woman presented with an incidentally found intracardiac mass. Transesophageal echocardiography (TEE) showed a 26 × 8 mm mobile mass attached to a calcified posterolateral mitral annulus. The mass was removed with a commercially available percutaneous catheter system using cerebral embolic protection and TEE guidance. The pathologic examination showed caseous mitral annular calcification.
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Affiliation(s)
- Hilal Olgun Kucuk
- Cardiovascular Medicine Department, Mayo Clinic, Rochester, Minnesota, USA
| | - John Z. Nan
- Cardiovascular Medicine Department, Mayo Clinic, Rochester, Minnesota, USA
| | - Kathryn F. Larson
- Cardiovascular Medicine Department, Mayo Clinic, Rochester, Minnesota, USA
| | - Lawrence J. Sinak
- Cardiovascular Medicine Department, Mayo Clinic, Rochester, Minnesota, USA
| | - Mackram F. Eleid
- Cardiovascular Medicine Department, Mayo Clinic, Rochester, Minnesota, USA
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3
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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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Riad M, Rahman MU, Mulyala R, Sayyed N, Bayer D, Omar B. Percutaneous Intracardiac Mass Extraction in High Surgical-Risk Patients. J Med Cases 2023; 14:362-368. [PMID: 38029057 PMCID: PMC10681765 DOI: 10.14740/jmc4150] [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: 10/19/2023] [Accepted: 11/03/2023] [Indexed: 12/01/2023] Open
Abstract
Large intracardiac masses including tumors, thrombi, and vegetations result in detrimental embolic or obstructive sequelae and present a management dilemma. Open heart surgery, the traditional approach, may not be an option for many patients with a prohibitive surgical risk due to multiple comorbidities. Recently, percutaneous options have emerged with reported success in extracting such intracardiac masses. A 42-year-old female with history of advanced primary sclerosing cholangitis with decompensated liver cirrhosis causing ascites and variceal bleed presented to the emergency department with fatigue, subjective fevers, chills and melena. Laboratory results revealed neutrophil-predominant leukocytosis and normocytic anemia, and blood cultures were positive for Candida albicans. Electrocardiography showed sinus tachycardia. Chest X-ray was unremarkable. She underwent packed red blood cell transfusion and esophageal banding for variceal bleeding. Transthoracic echocardiogram revealed normal left ventricular ejection fraction and no wall motion abnormalities. A right atrial mobile mass measuring approximately 1.0 × 3.0 cm was noted. Multidisciplinary heart team discussion concluded that while the mass posed a high embolic risk, the patient had a prohibitive risk for surgical intervention. Successful percutaneous removal of the mass using Penumbra system device (Penumbra Incorporated, Alameda, CA) was accomplished. This case report details the procedure and outcomes, as well as presents a literature review.
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Affiliation(s)
- Mariam Riad
- Cardiology Division, University of South Alabama, Mobile, AL 36617, USA
| | | | | | - Nadia Sayyed
- Department of Internal Medicine, Khyber Medical College, Peshawar, Pakistan
| | - Danielle Bayer
- Cardiology Division, University of South Alabama, Mobile, AL 36617, USA
| | - Bassam Omar
- Cardiology Division, University of South Alabama, Mobile, AL 36617, USA
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5
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Olagunju A, Martinez J, Kenny D, Gideon P, Mookadam F, Unzek S. Virulent endocarditis due to Haemophilus parainfluenzae: A systematic review of the literature. World J Cardiol 2022; 14:546-556. [PMID: 36339888 PMCID: PMC9627352 DOI: 10.4330/wjc.v14.i10.546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 08/27/2022] [Accepted: 09/16/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Haemophilus parainfluenzae (HPI) belongs to the HACEK (Haemophilus spp., Aggregatibacter spp., Cardiobacterium spp., Eikenella spp., and Kingella spp.) group of organisms. The HACEK group of organisms are a part of the oropharyngeal flora and can cause invasive opportunistic infection such infective endocarditis (IE) in hosts with compromised immunological barriers.
AIM To perform a 20-year systematic review of the literature characterizing the clinical presentation, epidemiology and prognosis of HPI IE.
METHODS We performed a systematic review of Medline, Pubmed, Scopus and Embase from 2000 to 2022 to identify all cases of HPI IE.
RESULTS Thirty-nine adult cases were identified. HPI IE was found to affect males slightly more than females and is common in patients with predisposing risk factors such as underlying valvular abnormalities. It mostly affected the mitral valve and had an indolent course; significantly sized vegetations (> 1 cm) developed in most cases. Central nervous system septic embolization was common. It had a favorable prognosis compared to staphylococcal and streptococcal IE.
CONCLUSION Clinicians should be attentive to the indolent course of HPI IE and the presence of predisposing risk factors in order to allow for timely management.
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Affiliation(s)
- Abdulbaril Olagunju
- Department of Internal Medicine, Creighton University School of Medicine, Phoenix, AZ 85013, United States
| | - Jake Martinez
- Department of Cardiology, Heart Center, University of Arizona College of Medicine-Phoenix, Banner University Medical Center, Phoenix, AZ 85006, United States
| | - Dorothy Kenny
- Department of Internal Medicine, Creighton University School of Medicine, Phoenix, AZ 85013, United States
| | - Philip Gideon
- Department of Cardiology, Heart Center, University of Arizona College of Medicine-Phoenix, Banner University Medical Center, Phoenix, AZ 85006, United States
| | - Farouk Mookadam
- Department of Cardiology, Heart Center, University of Arizona College of Medicine-Phoenix, Banner University Medical Center, Phoenix, AZ 85006, United States
- Department of Cardio-oncology, Banner MD Anderson Cancer Center, Phoenix, AZ 85006, United States
| | - Samuel Unzek
- Department of Cardiology, Heart Center, University of Arizona College of Medicine-Phoenix, Banner University Medical Center, Phoenix, AZ 85006, United States
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Mhanna M, Beran A, Al-Abdouh A, Jabri A, Sajdeya O, Al-Aaraj A, Alharbi A, Khuder SA, Eltahawy EA. AngioVac for Vegetation Debulking in Right-sided Infective Endocarditis: A Systematic Review and Meta-Analysis. Curr Probl Cardiol 2022; 47:101353. [PMID: 35961428 DOI: 10.1016/j.cpcardiol.2022.101353] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 08/04/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To investigate the utility of AngioVac-assisted vegetation debulking (AVD) in right sided infective endocarditis (RSIE) BACKGROUND: : AngioVac is a vacuum-based device that was approved in 2014 for the percutaneous removal of undesirable materials from the intravascular system. Although there are multiple reports on the use of the AngioVac device to aspirate right-sided heart chamber thrombi, data on its use to treat RSIE is limited. METHODS We performed a comprehensive literature search for studies that evaluated the utility of AVD. The primary outcomes of our study were the procedural success, defined as the ability of AngioVac to produce residual vegetation size <50% (RVS<50%) without serious procedural complications, and the clinical success, defined as composite of RVS<50%, in-hospital survival, absence of recurrent bacteremia, and valve function not requiring further intervention. The secondary outcomes included the individual components of the primary outcomes and average length of hospital stay. The pooled means and proportions of our data were analyzed using random effects model, generic inverse variance method, and represented with 95% confidence intervals (CIs). RESULTS A total of 44 studies, including 301 patients (mean age: 44.6±18.2 years, 71.6% males) were included. Procedural success was achieved in 89.2% of patients (95% CI:82.3%-93.6%, I2=0%). Clinical success was achieved in 79.1% of patients (95%CI:67.9%-87.2%, I2=15%). Overall survival rate was 89.7% (95% CI:83.1%-93.9%%, I2=9%). CONCLUSIONS Our meta-analysis demonstrates that AVD is a promising therapeutic option for RSIE offering a high success rate with an acceptable complication rate across a wide range of patients.
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Affiliation(s)
- Mohammed Mhanna
- Division of Cardiology, Department of Medicine, University of Iowa, Iowa City, IA, USA.
| | - Azizullah Beran
- Department of Gastroenterology, Indiana University, Indianapolis, IN, USA
| | - Ahmad Al-Abdouh
- Department of Internal Medicine, University of Kentucky, Lexington, KY, USA
| | - Ahmad Jabri
- Department of Cardiology, Case Western Reserve University/MetroHealth Medical Center, Cleveland, Ohio
| | - Omar Sajdeya
- Department of Internal Medicine, University of Toledo, Toledo, OH, USA
| | - Ahmad Al-Aaraj
- Department of Cardiology, James Cook University Hospital, Middlesbrough, England
| | | | - Sadik A Khuder
- Department of Medicine and Public Health, University of Toledo, Toledo, OH, USA
| | - Ehab A Eltahawy
- Department of Cardiovascular Medicine, University of Toledo, Toledo, OH, USA
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7
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Memon S, Goldman S, Hawthorne KM, Gnall EM. Percutaneous transeptal mitral valve endocarditis debulking with AngioVac aspiration system. Catheter Cardiovasc Interv 2022; 100:667-673. [PMID: 35907255 DOI: 10.1002/ccd.30319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/30/2022] [Accepted: 06/03/2022] [Indexed: 11/12/2022]
Abstract
Vacuum assisted aspiration with the AngioVac system has been well described for; right sided endocarditis, venous thrombus, lead related infection/thrombus aspiration and right sided cardiac mass evacuation. Percutaneous transeptal debulking with AngioVac for mitral valve endocarditis (MVE) in the inoperable or high surgical risk patient has not been well defined. A significant proportion of high/prohibitive surgical risk patients with left sided infective endocarditis (IE) are not offered valve surgery as patients in the acute active phase of IE have a high surgical mortality. Nonetheless, sequala of acute IE ie stroke, sepsis or hemodynamic instability in itself is associated with high morbidity and mortality without surgical treatment. A case report of an inoperable patient with methicillin sensitive staphylococcus aureus MVE who was offered MV vegetation debulking with the AngioVac Gen3 C 180 MV system is described. Preprocedural planning with attention to; optimal transeptal height puncture, use of sentinel cerebral protection device to decrease risk of procedure related cerebral embolism and venous extracorporeal membrane cannula, rather than arterial cannula for reinfusion, is described to avoid large bore arterial access related vascular complications. Further studies in a randomized manner are warranted to test these procedural techniques and determine outcomes of percutaneous aspiration of left sided IE with the AngioVac system in this highrisk inoperable cohort of patients.
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Affiliation(s)
- Sehrish Memon
- Division of Cardiovascular and Structural Heart Disease, Lankenau Medical Center and Lankenau Institute of Medical Research, Wynnewood, Pennsylvania, USA
| | - Scott Goldman
- Division of Cardiothoracic Surgery, Lankenau Medical Center and Lankenau Institute of Medical Research, Wynnewood, Pennsylvania, USA
| | - Katie M Hawthorne
- Division of Cardiovascular and Structural Heart Disease, Lankenau Medical Center and Lankenau Institute of Medical Research, Wynnewood, Pennsylvania, USA
| | - Eric M Gnall
- Division of Cardiovascular and Structural Heart Disease, Lankenau Medical Center and Lankenau Institute of Medical Research, Wynnewood, Pennsylvania, USA
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Becker MC, Reddy S, Miccio B, Pappas O. A novel technique for the percutaneous removal of tricuspid valve vegetations utilizing the Inari Flowtriever System. Catheter Cardiovasc Interv 2022; 100:261-265. [PMID: 35652174 DOI: 10.1002/ccd.30294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 05/05/2022] [Accepted: 05/14/2022] [Indexed: 11/10/2022]
Abstract
Right-sided infective endocarditis is a common entity for which surgical intervention is frequently high-risk. Considering its invasive nature, potential complications, and challenging patient population, a less invasive endovascular option is desirable. The previous series have demonstrated the feasibility of percutaneous therapy for tricuspid valve (TV) vegetation utilizing a filter-based bypass circuit. However, the limited availability of a specialized team, resources, procedural complexity, and large bore sheath size restrict the broad adoption of this technique. The Inari FlowTriever System (Inari Medical) is an endovascular, catheter-based, aspiration, and mechanical thrombectomy system indicated for the removal of large-volume venous thrombus and pulmonary emboli. Independent of anesthesia, perfusion, or advanced imaging, this device's characteristics uniquely improve the operator's ability to safely remove unwanted debris from complex anatomy. This report describes the first, utilization of the Inari FlowTriever System for the removal of massive and inoperable TV vegetation.
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Affiliation(s)
- Matthew C Becker
- Allegheny Health Network, Saint Vincent Heart and Vascular Institute, Erie, Pennsylvania, USA
| | - Siddarth Reddy
- Allegheny Health Network, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | - Brendan Miccio
- Division of Internal medicine, Lake Erie College of Medicine, Erie, Pennsylvania, USA
| | - Orestis Pappas
- Allegheny Health Network, Saint Vincent Heart and Vascular Institute, Erie, Pennsylvania, USA
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9
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Endovascular Treatment of Right Heart Masses Utilizing the AngioVac System: A 6-Year Single-Center Observational Study. J Interv Cardiol 2021; 2021:9923440. [PMID: 34803526 PMCID: PMC8572623 DOI: 10.1155/2021/9923440] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 09/27/2021] [Accepted: 10/12/2021] [Indexed: 11/17/2022] Open
Abstract
Objective To describe our institution's experience with the AngioVac system. Background Intracardiac and intravascular masses previously required surgical excision, but now, there are a number of minimally invasive options. With the advent of vacuum aspiration, more specifically the AngioVac System (AngioDynamics, NY, USA), there exists a system with both low mortality and minor complications. However, the number of retrospective studies remains limited. Outcome data for high-risk patients are also limited. Methods Data were collected and analyzed in patients who underwent AngioVac therapy at our tertiary care center from January 2014 to December 2020. Results Our results demonstrated a 93.3% intraoperative success rate and a 100% intraoperative survival rate. However, a number of complications, including but not limited to hematomas, anemia, and hypotension, occurred, as described below. Conclusions Our experiences demonstrated good outcomes and continue to support the usefulness of the AngioVac System. The data also support the use of AngioVac as a treatment option for the debulking or removal of right heart masses in critically ill patients.
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10
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Hammad TA, Abu-Omar Y, Shishehbor MH. Novel intracardiac echocardiography-guided catheter-based removal of inoperable tricuspid valve vegetation. Catheter Cardiovasc Interv 2021; 99:508-511. [PMID: 34766706 DOI: 10.1002/ccd.29999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 09/02/2021] [Accepted: 10/20/2021] [Indexed: 11/06/2022]
Abstract
With the ongoing intravenous drug abuse (IVDA) epidemic, the number of IVDA patients with infective endocarditis is increasing. These cases are often characterized by large vegetations complicated by valvular dysfunction, heart failure, and recurrent septic pulmonary emboli demanding surgical intervention. Latter cannot be offered in a good proportion of the patients due to challenging medical and social complexities. Hence, AngioVac system has been used as an alternative therapy; however, it is associated with high procedural mortality. In this document, we describe in detail the successful treatment of a case of large tricuspid valve vegetation, with prohibitive risk for surgery, using a percutaneous catheter-based system, the Triever aspiration catheter with FLEX technology, with the guidance of intracardiac echocardiogram.
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Affiliation(s)
- Tarek A Hammad
- University Hospitals Harrington Heart & Vascular Institute, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Yasir Abu-Omar
- University Hospitals Harrington Heart & Vascular Institute, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Mehdi H Shishehbor
- University Hospitals Harrington Heart & Vascular Institute, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
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11
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Kang J, Fleischman F, Saremi F, Shavelle DM. En Bloc AngioVac Removal of Thoracic Aortic Mass. Tex Heart Inst J 2021; 47:315-318. [PMID: 33472232 DOI: 10.14503/thij-18-6917] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The AngioVac system, designed for suction during extracorporeal bypass, is used to aspirate masses, thrombi, and other undesirable material from the cardiovascular system. To date, it has been used extensively in the venous system and right side of the heart; however, its use in the arterial system has been limited because of smaller vessel sizes and the requirement for a 26F sheath. We report the case of a 45-year-old woman with a history of angiosarcoma who presented with acute embolic events that affected her spleen and lower extremities. We removed a large mobile mass en bloc from her distal thoracic aorta by using the AngioVac system as an alternative to surgical resection. The patient recovered with no recurrence. We discuss the benefits and challenges of using the AngioVac within small vessels of the arterial system.
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Affiliation(s)
- Jeanney Kang
- Department of Internal Medicine, University of Southern California, Los Angeles, California 90033
| | - Fernando Fleischman
- Division of Cardiothoracic Surgery, University of Southern California, Los Angeles, California 90033
| | - Farhood Saremi
- Department of Radiology, University of Southern California, Los Angeles, California 90033
| | - David M Shavelle
- MemorialCare Heart & Vascular Institute, Long Beach Medical Center, Long Beach, California 90806
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12
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Aspiración de trombo auricular mediante sistema AngioVac: una alternativa cuando ni la cirugía ni la anticoagulación son una opción. Rev Esp Cardiol (Engl Ed) 2021. [DOI: 10.1016/j.recesp.2020.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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13
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Atrial thrombus aspiration through the AngioVac system: an alternative when surgery and anticoagulation are not an option. ACTA ACUST UNITED AC 2021; 74:626-628. [PMID: 33637474 DOI: 10.1016/j.rec.2020.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 12/10/2020] [Indexed: 11/22/2022]
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14
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Shmueli H, Thomas F, Flint N, Setia G, Janjic A, Siegel RJ. Right-Sided Infective Endocarditis 2020: Challenges and Updates in Diagnosis and Treatment. J Am Heart Assoc 2020; 9:e017293. [PMID: 32700630 PMCID: PMC7792231 DOI: 10.1161/jaha.120.017293] [Citation(s) in RCA: 109] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Compared with the extensive data on left-sided infective endocarditis (IE), there is much less published information on the features and management of right-sided IE. Right-sided IE accounts for 5% to 10% of all IE cases, and compared with left-sided IE, it is more often associated with intravenous drug use, intracardiac devices, and central venous catheters, all of which has become more prevalent over the past 20 years. In this manuscript on right-sided IE we provide an up-to-date overview on the epidemiology, etiology, microbiology, potential locations of infection in the right heart, diagnosis, imaging, common complications, management, and prognosis. We present updated information on the treatment of pacemaker and device infections, infected fibrin sheaths that appear to be an easily missed source of infection after central line as well as pacemaker removal. We review current data on the AngioVac percutaneous aspiration device, which can obviate the need for surgery in patients with infected pacemaker leads and fibrin sheaths. We also focused on advanced diagnostic modalities, such as positron emission tomography/computed tomography. All of these are supported by specific case examples with detailed echocardiographic imaging from our experience.
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Affiliation(s)
- Hezzy Shmueli
- Smidt Heart Institute Cedars-Sinai Medical Center Los Angeles CA
| | - Felix Thomas
- Smidt Heart Institute Cedars-Sinai Medical Center Los Angeles CA
| | - Nir Flint
- Smidt Heart Institute Cedars-Sinai Medical Center Los Angeles CA.,Department of Cardiology Tel Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Gayatri Setia
- Smidt Heart Institute Cedars-Sinai Medical Center Los Angeles CA
| | | | - Robert J Siegel
- Smidt Heart Institute Cedars-Sinai Medical Center Los Angeles CA
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15
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Fallon JM, Newman N, Patel PM, Keeling W, Attia T, Miller JS, Jaber W, Duwayri Y, Wagh K, Lattouf O. Vacuum-assisted extraction of ilio-caval and right heart masses: A 5-year single center experience. J Card Surg 2020; 35:1787-1792. [PMID: 32557825 DOI: 10.1111/jocs.14711] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 05/14/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Despite paucity of data, there exists growing popularity of catheter-based extraction methods for intravascular thrombi and vegetations. We describe a large single center experience with vacuum-assisted extraction techniques (VAET) for right-sided intravascular and cardiac masses. METHODS We retrospectively reviewed the perioperative course of patients undergoing VAET between 2014 and 2019. Primary outcomes were survival and freedom from recurrent bacteremia. Procedural success was a composite definition of survival, majority of mass extraction, absence of recurrent bacteremia, and valve function not requiring further intervention during index hospitalization. RESULTS Of the entire cohort (n = 58), 48% and 52% underwent VAET for vegetations and sterile thrombi, respectively. Of those with positive cultures, the most common organism isolated was Staphylococcus aureus (48%). Preoperative active bacteremia was present in 36% (21/58) and of these patients, 76% (16/21) had neither recurrent nor persistent bacteremia post-op. The majority of masses (67%, 38/58) were debulked with an average reduction in size of 42%. Conversion to open surgery occurred in 3.5% (2/58). Intraoperative and 30-day survival were 98% (57/58) and 90% (28/31), respectively. Overall success was 86% (50/58). The prevalence of moderate/severe tricuspid regurgitation was 37% pre-op and 61% post-op. Average length of intensive care unit and overall hospital stay was 5.6 and 16 days, respectively. CONCLUSIONS In this single center experience, VAET was conducted safely with a high degree of success and freedom from short-term recurrent bacteremia. This minimally invasive procedure is an attractive alternative to traditional open techniques for removal of right-sided intravascular and cardiac masses.
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Affiliation(s)
- John M Fallon
- Department of Cardiothoracic Surgery, Emory University, Atlanta, Georgia
| | | | - Parth M Patel
- Department of Cardiothoracic Surgery, Emory University, Atlanta, Georgia
| | - William Keeling
- Department of Cardiothoracic Surgery, Emory University, Atlanta, Georgia
| | - Tamer Attia
- Department of Cardiothoracic Surgery, Emory University, Atlanta, Georgia
| | - Jeffrey S Miller
- Department of Cardiothoracic Surgery, Emory University, Atlanta, Georgia
| | - Wissam Jaber
- Department of Cardiothoracic Surgery, Emory University, Atlanta, Georgia
| | - Yazan Duwayri
- Department of Cardiothoracic Surgery, Emory University, Atlanta, Georgia
| | - Kaustubh Wagh
- Department of Cardiothoracic Surgery, Emory University, Atlanta, Georgia
| | - Omar Lattouf
- Department of Cardiothoracic Surgery, Emory University, Atlanta, Georgia
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16
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Percutaneous Vacuum-Assisted Thrombectomy Using AngioVac Aspiration System. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 21:489-493. [PMID: 31882331 DOI: 10.1016/j.carrev.2019.12.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 12/03/2019] [Accepted: 12/16/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND Surgical embolectomy and thrombolytic therapy are two common approaches for the treatment of large intra-cardiac or intravascular thrombi to prevent new or worsening pulmonary embolism (PE). Considering high operative mortality with surgical embolectomy and high bleeding risk with thrombolytic therapy, patients who are poor candidates for these treatments may benefit from percutaneous aspiration thrombectomy/Vacuum-assisted thrombectomy (VAT). AngioVac aspiration system was granted 510(k) clearance by the United States Food and Drug Administration (FDA) in April 2009. We present a case series to describe its use and outcomes in evacuating large caval thrombi or intracardiac masses. METHODS We did a retrospective analysis of AngioVac catheter based thrombectomy in 16 consecutive patients treated between January 2016 and January 2019 to report case characteristics and in-hospital clinical outcomes. RESULTS Sixteen patients (mean age 48) underwent 16 AngioVac procedures over 48 months. Indications included intracardiac mass (68.8%), caval thrombus (56.3%), and catheter associated thrombus (43.8%). 7 (43.8%) patients had concurrent PE. Peri-procedure mortality was 0% and in-hospital mortality was 12.5% at a mean follow-up of 14 days. There were no pulmonary hemorrhages, strokes or myocardial infarctions. 62.5% had a significant drop in hemoglobin, which required a blood transfusion but there was no episode of overt bleeding. CONCLUSION The AngioVac aspiration system has been shown to be effective at aspirating large volumes of intravascular and intracardiac thrombus. It is a reasonable alternative to surgical thrombectomy in patients with large central thrombi or masses in-transit who are at risk of complicated PE.
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17
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Seiler A, Gnadinger P, Glotzbach J, Silverton NA. Transesophageal Echocardiography-Guided Tumor/Thrombus Debulking Using the AngioVac Transcatheter Aspiration Device. J Cardiothorac Vasc Anesth 2019; 34:1005-1009. [PMID: 31735427 DOI: 10.1053/j.jvca.2019.10.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 10/06/2019] [Accepted: 10/11/2019] [Indexed: 12/26/2022]
Affiliation(s)
- Arran Seiler
- University of Utah Department of Anesthesiology, Salt Lake City, UT
| | | | - Jason Glotzbach
- University of Utah Department of Surgery, Division of Cardiothoracic Surgery, Salt Lake City, UT
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18
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Kiani S, Sabayon D, Lloyd MS, Hoskins MH, El‐Chami MF, Westerman S, Vadlamudi R, Keeling B, Lattouf OM, Merchant FM. Outcomes of percutaneous vacuum‐assisted debulking of large vegetations as an adjunct to lead extraction. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:1032-1037. [DOI: 10.1111/pace.13726] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 04/10/2019] [Accepted: 05/12/2019] [Indexed: 12/30/2022]
Affiliation(s)
- Soroosh Kiani
- Division of Cardiology, Department of MedicineEmory University School of Medicine Atlanta Georgia
| | - Dean Sabayon
- Division of Cardiology, Department of MedicineEmory University School of Medicine Atlanta Georgia
| | - Michael S. Lloyd
- Division of Cardiology, Department of MedicineEmory University School of Medicine Atlanta Georgia
| | - Michael H. Hoskins
- Division of Cardiology, Department of MedicineEmory University School of Medicine Atlanta Georgia
| | - Mikhael F. El‐Chami
- Division of Cardiology, Department of MedicineEmory University School of Medicine Atlanta Georgia
| | - Stacy Westerman
- Division of Cardiology, Department of MedicineEmory University School of Medicine Atlanta Georgia
| | - Ratna Vadlamudi
- Department of AnesthesiologyEmory University School of Medicine Atlanta Georgia
| | - Brent Keeling
- Division of Cardiothoracic Surgery, Department of SurgeryEmory University School of Medicine Atlanta Georgia
| | - Omar M. Lattouf
- Division of Cardiothoracic Surgery, Department of SurgeryEmory University School of Medicine Atlanta Georgia
| | - Faisal M. Merchant
- Division of Cardiology, Department of MedicineEmory University School of Medicine Atlanta Georgia
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19
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Hameed I, Lau C, Khan FM, Wingo M, Rahouma M, Leonard JR, Di Franco A, Worku BM, Salemi A, Girardi LN, Gaudino M. AngioVac for extraction of venous thromboses and endocardial vegetations: A meta‐analysis. J Card Surg 2019; 34:170-180. [DOI: 10.1111/jocs.14009] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 01/24/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Irbaz Hameed
- Department of Cardiothoracic SurgeryWeill Cornell MedicineNew York New York
| | - Christopher Lau
- Department of Cardiothoracic SurgeryWeill Cornell MedicineNew York New York
| | - Faiza M. Khan
- Department of Cardiothoracic SurgeryWeill Cornell MedicineNew York New York
| | - Matthew Wingo
- Department of Cardiothoracic SurgeryWeill Cornell MedicineNew York New York
| | - Mohamed Rahouma
- Department of Cardiothoracic SurgeryWeill Cornell MedicineNew York New York
| | - Jeremy R. Leonard
- Department of Cardiothoracic SurgeryWeill Cornell MedicineNew York New York
| | - Antonino Di Franco
- Department of Cardiothoracic SurgeryWeill Cornell MedicineNew York New York
| | - Berhane M. Worku
- Department of Cardiothoracic SurgeryWeill Cornell MedicineNew York New York
| | - Arash Salemi
- Department of Cardiothoracic SurgeryWeill Cornell MedicineNew York New York
| | - Leonard N. Girardi
- Department of Cardiothoracic SurgeryWeill Cornell MedicineNew York New York
| | - Mario Gaudino
- Department of Cardiothoracic SurgeryWeill Cornell MedicineNew York New York
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20
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Koney N, Benmessaoud C, Cole KY, Bulut Y, Yang EH, Moriarty JM. Percutaneous Removal of a Cardiac Mass in a Patient with Infective Endocarditis: A Case Report. J Pediatr Intensive Care 2018; 8:103-107. [PMID: 31093464 DOI: 10.1055/s-0038-1675194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 09/10/2018] [Indexed: 10/28/2022] Open
Abstract
Infective endocarditis (IE) in the pediatric population is uncommon and presents with nonspecific signs. Nonetheless, prompt diagnosis and management are critical given its high mortality rate. We present the case of a 15-year-old boy who initially presented with bilateral multifocal pneumonia and was found to have IE with a right ventricular vegetation. The vegetation was removed percutaneously, obviating a more invasive surgical approach. The patient tolerated the procedure well and rapidly improved following removal of the vegetation. This case report highlights the utility of a novel, minimally invasive approach for the management of cardiac masses.
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Affiliation(s)
- Nii Koney
- Division of Interventional Radiology, Department of Radiological Sciences, University of California, Los Angeles, California, United States.,Division of Interventional Radiology, Department of Radiology, Northwest Permanente, Portland, Oregon, United States
| | - Chelsea Benmessaoud
- David Geffen School of Medicine, University of California, Los Angeles, California, United States
| | - Kalonji Y Cole
- David Geffen School of Medicine, University of California, Los Angeles, California, United States
| | - Yonca Bulut
- Division of Critical Care Medicine, Department of Pediatrics, University of California, Los Angeles, California, United States
| | - Eric H Yang
- Division of Cardiology, Department of Medicine, University of California, Los Angeles, California, United States
| | - John M Moriarty
- Division of Interventional Radiology, Department of Radiological Sciences, University of California, Los Angeles, California, United States.,Division of Cardiology, Department of Medicine, University of California, Los Angeles, California, United States
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21
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Ahmed M, Montford JH, Lau E. Vacuum-assisted right atrial infected clot extraction due to persistent bacteraemia: a percutaneous approach for the management of right-sided endocarditis. BMJ Case Rep 2018; 2018:bcr-2018-226493. [PMID: 30181406 DOI: 10.1136/bcr-2018-226493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 56-year-old woman with non-ischaemic cardiomyopathy with implantable cardioverter defibrillator (ICD) presented to the hospital with progressive dyspnoea of 4 weeks' duration. She soon spiralled down to develop septic shock with methicillin-sensitive Staphylococcus aureus bacteraemia. A transoesophageal echocardiogram revealed a 2.4×2.1 cm large mobile echodensity in the right atrium likely attached to the ICD lead and to the interatrial septum. Although the ICD along with its leads was extracted, bacteraemia persisted despite appropriate antibiotic therapy. Because of her worsening condition, she underwent a right atrial infected clot extraction by the AngioVac system. Her clinical condition noticeably improved soon after evacuation of the infected clot.
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Affiliation(s)
- Mashrafi Ahmed
- Department of Cardiovascular Medicine, Baystate Medical Center, Springfield, Illinois, USA
| | | | - Evan Lau
- Department of Cardiovascular Medicine, Baystate Medical Center, Springfield, Illinois, USA
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22
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Patel N, McDonald ML, Bradford NS, Smith JW, Beaty EH, Rytlewski JA, Simmons TW, Whalen P, Zhao DX, Bhave PD. AngioVac Debulking in Endocarditis Patients with Large, Device-related Vegetations. J Innov Card Rhythm Manag 2018; 9:3291-3296. [PMID: 32494503 PMCID: PMC7252890 DOI: 10.19102/icrm.2018.090803] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 12/04/2017] [Indexed: 12/13/2022] Open
Abstract
As the number and complexity of cardiovascular implantable electronic devices has increased, so too has the incidence of device-related infections. Such a rise requires that the focus be directed toward developing universal standards for infected lead removal. To date, no consensus currently exists regarding the optimal management of patients with large vegetations (diameter > 2 cm). In these individuals, medical therapy is universally ineffective and they are often too ill for surgical extraction; furthermore, transvenous lead extraction (TLE) carries with it a risk of large septic pulmonary emboli. We present a series of five cases in which the AngioVac thrombectomy system (AngioDynamics Inc., Latham, NY, USA) was used as an adjunct to TLE. Debridement of infected leads prior to percutaneous lead extraction was accomplished as either a bridge to or as concomitant therapy with laser lead removal at our institution. This study included three males and two females with an average age of 52 years. The sizes of vegetations removed from leads ranged from 1.5 cm to 3.9 cm in the largest dimension and the average diameter was 2.65 cm ± 1.1 cm. The vegetations were successfully debulked in all five patients. This suggests that TLE performed with assistance from the AngioVac system (AngioDynamics Inc., Latham, NY, USA) is a safe and effective alternative to open surgical lead removal in patients with large lead vegetations.
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Affiliation(s)
- Nikhil Patel
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - M Lawson McDonald
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Natalie S Bradford
- Section on Cardiology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Justin W Smith
- Section on Cardiology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Elijah H Beaty
- Section on Cardiology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jason A Rytlewski
- Section on Cardiology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Tony W Simmons
- Section on Cardiology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Patrick Whalen
- Section on Cardiology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - David X Zhao
- Section on Cardiology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Prashant D Bhave
- Section on Cardiology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
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23
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Godara H, Jia KQ, Augostini RS, Houmsse M, Okabe T, Hummel JD, Weiss R, Kalbfleisch SJ, Afzal MR, Badin A, Cavalcanti R, Franco DA, Tyler J, Daoud EG. Feasibility of concomitant vacuum-assisted removal of lead-related vegetations and cardiac implantable electronic device extraction. J Cardiovasc Electrophysiol 2018; 29:1460-1466. [DOI: 10.1111/jce.13692] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 06/27/2018] [Accepted: 06/29/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Hemant Godara
- Division of Cardiovascular Medicine; The Ohio State University Wexner Medical Center; Columbus Ohio
| | - Kelly Qi Jia
- Department of Internal Medicine; The Ohio State University Wexner Medical Center; Columbus Ohio
| | - Ralph S. Augostini
- Division of Cardiovascular Medicine; The Ohio State University Wexner Medical Center; Columbus Ohio
| | - Mahmoud Houmsse
- Division of Cardiovascular Medicine; The Ohio State University Wexner Medical Center; Columbus Ohio
| | - Toshimasa Okabe
- Division of Cardiovascular Medicine; The Ohio State University Wexner Medical Center; Columbus Ohio
| | - John D. Hummel
- Division of Cardiovascular Medicine; The Ohio State University Wexner Medical Center; Columbus Ohio
| | - Raul Weiss
- Division of Cardiovascular Medicine; The Ohio State University Wexner Medical Center; Columbus Ohio
| | - Steven J. Kalbfleisch
- Division of Cardiovascular Medicine; The Ohio State University Wexner Medical Center; Columbus Ohio
| | - Muhammad R. Afzal
- Division of Cardiovascular Medicine; The Ohio State University Wexner Medical Center; Columbus Ohio
| | - Auroa Badin
- Division of Cardiovascular Medicine; The Ohio State University Wexner Medical Center; Columbus Ohio
| | - Rafael Cavalcanti
- Division of Cardiovascular Medicine; The Ohio State University Wexner Medical Center; Columbus Ohio
| | - Diego Alcivar Franco
- Division of Cardiovascular Medicine; The Ohio State University Wexner Medical Center; Columbus Ohio
| | - Jaret Tyler
- Division of Cardiovascular Medicine; The Ohio State University Wexner Medical Center; Columbus Ohio
| | - Emile G. Daoud
- Division of Cardiovascular Medicine; The Ohio State University Wexner Medical Center; Columbus Ohio
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24
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AngioVac System Used for Vegetation Debulking in a Patient with Tricuspid Valve Endocarditis: A Case Report and Review of the Literature. Case Rep Cardiol 2017; 2017:1923505. [PMID: 29238620 PMCID: PMC5697122 DOI: 10.1155/2017/1923505] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 10/03/2017] [Indexed: 12/21/2022] Open
Abstract
AngioVac is a vacuum-based device approved in 2014 for percutaneous removal of undesirable materials from the intravascular system. Although numerous reports exist with regard to the use of the AngioVac device in aspiration of iliocaval, pulmonary, upper extremity, and right-sided heart chamber thrombi, very few data are present demonstrating its use in treatment of right-sided endocarditis. In this case report, we describe the novel device used in debulking a large right-sided tricuspid valve vegetation reducing the occurrence of septic embolisation and enhancing the efficacy of antibiotics in clearance of bloodstream infection. Further research is needed in larger RSIE patient populations to confirm the benefits and the potential of improved outcomes associated with the AngioVac device as well as identify its potential complications.
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25
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Enezate TH, Kumar A, Aggarwal K, Balla S, Omran J. Non-surgical extraction of right atrial mass by AngioVac aspiration device under fluoroscopic and transesophageal echocardiographic guidance. Cardiovasc Diagn Ther 2017; 7:331-335. [PMID: 28567359 DOI: 10.21037/cdt.2016.09.03] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Right-sided cardiac masses are commonly encountered. We present a challenging case of a right atrial thrombus in a patient who had a high surgical risk for open removal. AngioVac aspiration device, under transesophageal echocardiography (TEE) and fluoroscopy guidance, was successfully used to remove the thrombus. The patient tolerated the procedure well and was discharged home. Our case confirms the safety and efficacy of this procedure for treatment of unwanted intracardiac and intravascular masses in patients who are not candidates for conventional therapies of surgery or thrombolytics.
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Affiliation(s)
- Tariq H Enezate
- Division of Cardiology, University of Missouri-Columbia, Columbia, MO 65201, USA
| | - Arun Kumar
- Division of Cardiology, University of Missouri-Columbia, Columbia, MO 65201, USA
| | - Kul Aggarwal
- Division of Cardiology, University of Missouri-Columbia, Columbia, MO 65201, USA
| | - Sudarshan Balla
- Division of Cardiology, University of Missouri-Columbia, Columbia, MO 65201, USA
| | - Jad Omran
- Division of Cardiology, University of Missouri-Columbia, Columbia, MO 65201, USA
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26
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Ram H, Gerlach RM, Hernandez Conte A, Ramzy D, Jaramillo-Huff AR, Gerstein NS. The AngioVac Device and Its Anesthetic Implications. J Cardiothorac Vasc Anesth 2017; 31:1091-1102. [DOI: 10.1053/j.jvca.2016.12.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Indexed: 11/11/2022]
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27
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George B, Voelkel A, Kotter J, Leventhal A, Gurley J. A novel approach to percutaneous removal of large tricuspid valve vegetations using suction filtration and veno-venous bypass: A single center experience. Catheter Cardiovasc Interv 2017; 90:1009-1015. [DOI: 10.1002/ccd.27097] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 01/30/2017] [Accepted: 03/25/2017] [Indexed: 11/07/2022]
Affiliation(s)
- Bennet George
- Department of Cardiovascular Medicine, Gill Heart & Vascular Institute; University of Kentucky Medical Center; Lexington Kentucky
| | - Anthony Voelkel
- Department of Cardiovascular Medicine; Ohio State University Wexner Medical Center; Columbus Ohio
| | - John Kotter
- Department of Cardiovascular Medicine, Gill Heart & Vascular Institute; University of Kentucky Medical Center; Lexington Kentucky
| | - Andrew Leventhal
- Department of Cardiovascular Medicine, Gill Heart & Vascular Institute; University of Kentucky Medical Center; Lexington Kentucky
| | - John Gurley
- Department of Cardiovascular Medicine, Gill Heart & Vascular Institute; University of Kentucky Medical Center; Lexington Kentucky
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28
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Al-Hakim R, Park J, Bansal A, Genshaft S, Moriarty JM. Early Experience with AngioVac Aspiration in the Pulmonary Arteries. J Vasc Interv Radiol 2017; 27:730-4. [PMID: 27106647 DOI: 10.1016/j.jvir.2016.01.012] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 01/04/2016] [Accepted: 01/05/2016] [Indexed: 02/06/2023] Open
Abstract
Five consecutive cases in which the AngioVac aspiration cannula was used for the management of pulmonary embolism (PE) were retrospectively reviewed. Four cases (80%) presented with massive PE, and two (40%) were technically successful (reduction in Miller index ≥ 5). Four patients (80%) died at a mean of 7.3 days after the procedure, including one death related to right ventricular free wall perforation. Although the AngioVac aspiration cannula has shown clinical promise in a variety of clinical applications, early experience in the pulmonary arteries has shown limited success, and further study and careful patient selection are required.
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Affiliation(s)
- Ramsey Al-Hakim
- Department of Radiology, Division of Interventional Radiology, University of California, Los Angeles, 757 Westwood Plaza, Suite 1638, Los Angeles, CA 90095.
| | - Jonathan Park
- Department of Radiology, Division of Interventional Radiology, University of California, Los Angeles, 757 Westwood Plaza, Suite 1638, Los Angeles, CA 90095
| | - Anshuman Bansal
- Department of Radiology, Division of Interventional Radiology, University of California, Los Angeles, 757 Westwood Plaza, Suite 1638, Los Angeles, CA 90095
| | - Scott Genshaft
- Department of Radiology, Division of Interventional Radiology, University of California, Los Angeles, 757 Westwood Plaza, Suite 1638, Los Angeles, CA 90095
| | - John M Moriarty
- Department of Radiology, Division of Interventional Radiology, University of California, Los Angeles, 757 Westwood Plaza, Suite 1638, Los Angeles, CA 90095
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29
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Abboud S, Raparia K, Ubago JM, Resnick S. AngioVac extraction of intra-atrial hepatoma masquerading as PICC-associated thrombus. Diagn Interv Radiol 2017; 22:72-4. [PMID: 26509915 DOI: 10.5152/dir.2015.15243] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Thrombus associated with peripherally inserted central catheterization is not uncommon. Treatment is typically conservative; however, more aggressive therapies can be considered in patients with tenuous medical condition. The authors present a patient with metastatic hepatocellular carcinoma masquerading as peripherally inserted central catheter-associated intra-atrial thrombus, subsequently removed via vacuum-assisted mechanical thrombectomy.
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Affiliation(s)
- Samir Abboud
- Department of Radiology, Northwestern Memorial Hospital, Chicago, Illinois, USA.
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30
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Factors Associated with Successful Thrombus Extraction with the AngioVac Device: An Institutional Experience. Ann Vasc Surg 2017; 38:242-247. [DOI: 10.1016/j.avsg.2016.04.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 01/13/2016] [Accepted: 04/12/2016] [Indexed: 02/03/2023]
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31
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Dalia AA, Bamira D, Albaghdadi M, Essandoh M, Rosenfield K, Dudzinski D. Four-Dimensional Transesophageal Echocardiography-Guided AngioVac Debulking of a Tricuspid Valve Vegetation. J Cardiothorac Vasc Anesth 2016; 31:1713-1716. [PMID: 28215497 DOI: 10.1053/j.jvca.2016.11.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Adam A Dalia
- Department of Anesthesiology, Pain Medicine, and Critical Care, The Massachusetts General Hospital, Harvard Medical School, Boston, MA.
| | - Daniel Bamira
- Department of Cardiology, The Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Mazen Albaghdadi
- Department of Interventional Cardiology, The Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Michael Essandoh
- Department of Anesthesiology, The Ohio State University, Wexner Medical Center, Columbus, OH
| | - Kenneth Rosenfield
- Department of Interventional Cardiology, The Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - David Dudzinski
- Department of Cardiology, The Massachusetts General Hospital, Harvard Medical School, Boston, MA
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32
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Patnaik S, Rammohan HS, Shah M, Garg S, Figueredo V, Janzer S, Shah S. Percutaneous Embolectomy of Serpentine Thrombus from the Right Atrium in a 51-Year-Old Man. Tex Heart Inst J 2016; 43:524-527. [PMID: 28100974 DOI: 10.14503/thij-15-5502] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Treatment of large, fresh thrombi in the vascular system can be challenging. AngioVac, a cardiopulmonary pump system, has been used to remove large thrombi and even some tumors by a percutaneous route. We report here a case of a 51-year-old man who presented with a large thrombus (7.5 × 1.5 cm) in his inferior vena cava, extending into his right atrium and right ventricle. Because the surgical risk was high, we attempted percutaneous embolectomy via the AngioVac aspiration system. We also review the literature concerning this emerging technique.
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33
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Worku B, Salemi A, D'Ayala MD, Tranbaugh RF, Girardi LN, Gulkarov IM. The Angiovac Device: Understanding the Failures on the Road to Success. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2016. [DOI: 10.1177/155698451601100611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Berhane Worku
- Department of Cardiothoracic Surgery, New York Methodist Hospital, Brooklyn, NY USA
- Department of Cardiothoracic Surgery, Weill Cornell Medical Center, New York Presbyterian Hospital, New York, NY USA
| | - Arash Salemi
- Department of Cardiothoracic Surgery, Weill Cornell Medical Center, New York Presbyterian Hospital, New York, NY USA
| | - Marcus D. D'Ayala
- Division of Vascular Surgery, New York Methodist Hospital, Brooklyn, NY USA
| | - Robert F. Tranbaugh
- Department of Cardiothoracic Surgery, New York Methodist Hospital, Brooklyn, NY USA
- Department of Cardiothoracic Surgery, Weill Cornell Medical Center, New York Presbyterian Hospital, New York, NY USA
| | - Leonard N. Girardi
- Department of Cardiothoracic Surgery, Weill Cornell Medical Center, New York Presbyterian Hospital, New York, NY USA
| | - Iosif M. Gulkarov
- Department of Cardiothoracic Surgery, New York Methodist Hospital, Brooklyn, NY USA
- Department of Cardiothoracic Surgery, Weill Cornell Medical Center, New York Presbyterian Hospital, New York, NY USA
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34
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The Angiovac Device: Understanding the Failures on the Road to Success. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2016; 11:430-433. [DOI: 10.1097/imi.0000000000000310] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Objective Current percutaneous thromboembolectomy techniques may obviate surgical intervention in high-risk patients with iliocaval thrombus or thrombus of the right side of the heart, but typically require thrombus fragmentation and thrombolysis with associated bleeding and thromboembolic complications. The AngioVac (Angiodynamics, Latham, NY USA) device uses a percutaneous venovenous bypass circuit to aspirate intact thrombus. A review of the literature was performed with regard to the AngioVac device to determine the factors correlating with successful thrombus extraction. Methods A literature search was performed with regard to use of the AngioVac device using the PubMed database. A meta-analysis was not performed given the small size and lack of statistical analysis of the individual reports included. Results Twenty-three reports describing 57 procedures in 56 patients were analyzed. Indications for thrombectomy included iliocaval thrombus in 53% (30), thrombus of the right side of the heart, in 49% (28), pulmonary embolus in 14% (8), and upper extremity venous/Glenn shunt thrombosis in 7% (4). The complete success rate, defined as removal of all thrombus, was 75% (43), with an 11% (6) partial success rate. In 14% (8) of cases, minimal or no thrombus was retrieved. When analyzed by indication, iliocaval thrombus and thrombus of the right side of the heart demonstrated 87% (26) and 82% (23) complete success rates, respectively. Pulmonary embolus demonstrated a significantly lower success rate at 12.5% [1; (P < .001)]. Complications occurred in 12% (7), including six hematomas and one retroperitoneal bleed. Conclusions The AngioVac device offers an excellent alternative to surgical thrombectomy for patients presenting with iliocaval or intracardiac thrombus, with success rates of more than 80%, although it seems that pulmonary emboli are less amenable. Appropriate patient selection can lead to improved outcomes. Larger numbers are needed to make more definite conclusions.
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Moriarty JM, Al-Hakim R, Bansal A, Park JK. Removal of Caval and Right Atrial Thrombi and Masses Using the AngioVac Device: Initial Operative Experience. J Vasc Interv Radiol 2016; 27:1584-91. [DOI: 10.1016/j.jvir.2016.03.045] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 03/29/2016] [Accepted: 03/29/2016] [Indexed: 11/30/2022] Open
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Renew JR, Wittwer ED, Robb TM, Fritock MD. AngioVac Removal of a Saddle Pulmonary Embolus Using TEE Guidance and Venoarterial ECMO Support. J Cardiothorac Vasc Anesth 2016; 30:749-52. [DOI: 10.1053/j.jvca.2015.10.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Indexed: 11/11/2022]
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Single-Center Experience Using AngioVac with Extracorporeal Bypass for Mechanical Thrombectomy of Atrial and Central Vein Thrombi. J Vasc Interv Radiol 2016; 27:723-729.e1. [DOI: 10.1016/j.jvir.2016.02.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 01/30/2016] [Accepted: 02/07/2016] [Indexed: 11/21/2022] Open
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Hosoba S, Mori M, Furtado AD, Lattouf OM. Extraction of Right-Sided Vegetation with Use of an Aspiration Catheter System. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2015. [DOI: 10.1177/155698451501000513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Soh Hosoba
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA USA
| | - Makoto Mori
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA USA
| | - Arul D. Furtado
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA USA
| | - Omar M. Lattouf
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA USA
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Extraction of Right-Sided Vegetation with Use of an Aspiration Catheter System. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2015; 10:357-9. [DOI: 10.1097/imi.0000000000000189] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Indications for surgical management of active right-sided endocarditis are under debate. In the presence of vegetation without valvular or surrounding tissue involvement, the mass may be removed with a suction device introduced via a transcatheter path. Herein, we report the successful removal of right-sided vegetation using the AngioVac Cannula, a percutaneous mechanical suction device, in three patients who presented with active endocarditis. The excellent midterm follow-up results highlight the effectiveness of such aspiration catheter systems.
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Salsamendi J, Doshi M, Bhatia S, Bordegaray M, Arya R, Morton C, Narayanan G. Single Center Experience with the AngioVac Aspiration System. Cardiovasc Intervent Radiol 2015; 38:998-1004. [DOI: 10.1007/s00270-015-1152-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 05/25/2015] [Indexed: 11/30/2022]
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Donaldson CW, Baker JN, Narayan RL, Provias TS, Rassi AN, Giri JS, Sakhuja R, Weinberg I, Jaff MR, Rosenfield K. Thrombectomy using suction filtration and veno-venous bypass: single center experience with a novel device. Catheter Cardiovasc Interv 2015; 86:E81-7. [PMID: 24975395 DOI: 10.1002/ccd.25583] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 06/22/2014] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To describe the first single center experience with a novel aspiration thrombectomy device. BACKGROUND The appearance of inferior vena cava or right-sided intracardiac thrombus may prompt consideration of percutaneous thrombectomy as a method to prevent new or worsening pulmonary embolism (PE). The AngioVac is a novel thrombectomy device composed of a cannula and extracorporeal circuit with filter for pump-assisted removal of intravascular debris which is coupled with a reinfusion catheter for return of blood to the patient. The device has been approved by the United States Food and Drug Administration since 2009. This report represents the first significant case series describing its use, feasibility and outcomes in evacuating large caval thrombi or intracardiac masses in PE. METHODS This is a retrospective analysis of patient and case characteristics and in-hospital clinical outcomes of AngioVac thrombectomy in 14 consecutive patients treated between April 2010 and July 2013 at our institution. RESULTS Fourteen consecutive patients (mean age 50, 64% female) underwent 15 AngioVac procedures over 40 months. Indications included intracardiac mass (73%), acute PE (33%), and caval thrombus (73%). Four patients (27%) were in shock at the start of the procedure. Peri-procedure mortality was 0% and in-hospital mortality was 13% at a mean follow-up of 23 days. There were no pulmonary hemorrhages, strokes or myocardial infarctions. Though 73% had a post procedural drop in hematocrit, only two bleeding events were related to access site and required a transfusion. CONCLUSIONS AngioVac thrombectomy is feasible in critically ill patients with acute DVT or PE and large caval thrombi or intracardiac masses.
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Affiliation(s)
- Cameron W Donaldson
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Joshua N Baker
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Rajeev L Narayan
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Tim S Provias
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Andrew N Rassi
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jay S Giri
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Rahul Sakhuja
- Cardiovascular Medicine/Intervention and Structural Heart Disease, Wellmont CVA Heart Institute, Kingsport, Tennessee
| | - Ido Weinberg
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Michael R Jaff
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kenneth Rosenfield
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Utilization of AngioVac and Snare for Eradication of a Mobile Right Atrial Thrombus. Ann Thorac Surg 2015; 99:698-700. [DOI: 10.1016/j.athoracsur.2014.04.060] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 03/19/2014] [Accepted: 04/04/2014] [Indexed: 11/21/2022]
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A Novel Technique for Endovascular Removal of Large Volume Right Atrial Tumor Thrombus. Cardiovasc Intervent Radiol 2014; 38:1021-4. [DOI: 10.1007/s00270-014-0986-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 08/10/2014] [Indexed: 10/24/2022]
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44
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AngioVac Aspiration for Paradoxical Emboli Protection through a Fenestrated Fontan During Central Venous Thrombus Manipulation. Cardiovasc Intervent Radiol 2014; 38:752-4. [DOI: 10.1007/s00270-014-0953-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 05/27/2014] [Indexed: 10/25/2022]
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Holcman K, Cameron SJ, Laskurain E, Massey HT, Trawick DR, Mieszczanska H. Breathtaking: Platypnea-orthodeoxia syndrome. Am J Med 2014; 127:491-3. [PMID: 24608022 DOI: 10.1016/j.amjmed.2014.02.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 02/25/2014] [Accepted: 02/25/2014] [Indexed: 11/18/2022]
Affiliation(s)
- Katarzyna Holcman
- Division of Cardiology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Scott J Cameron
- Division of Cardiology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Elixabeth Laskurain
- Division of Cardiology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - H Todd Massey
- Division of Cardiology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - David R Trawick
- Division of Cardiology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Hanna Mieszczanska
- Division of Cardiology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY.
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Wilner BR, Carrillo RG. Vacuum-Assisted Inferior Vena Cava Thrombus Removal Using a Percutaneous Technique. J Card Surg 2014; 30:265-7. [DOI: 10.1111/jocs.12366] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Bryan R. Wilner
- University of Miami Miller School of Medicine; Miami Florida
| | - Roger G. Carrillo
- Department of Cardiac Surgery; University of Miami Miller School of Medicine; Miami Florida
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Vacuum-Assisted Thrombectomy Device (AngioVac) in the Management of Symptomatic Iliocaval Thrombosis. J Vasc Interv Radiol 2014; 25:425-30. [DOI: 10.1016/j.jvir.2013.11.017] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 10/23/2013] [Accepted: 11/14/2013] [Indexed: 11/18/2022] Open
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Pasha AK, Elder MD, Khurram D, Snyder BA, Movahed MR. Successful management of acute massive pulmonary embolism using Angiovac suction catheter technique in a hemodynamically unstable patient. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2013; 15:240-3. [PMID: 24507854 DOI: 10.1016/j.carrev.2013.12.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 12/17/2013] [Indexed: 11/26/2022]
Abstract
Massive pulmonary embolism with hemodynamic instability is a life-threatening condition requiring immediate treatment. Urgent thrombectomy or thrombolysis is commonly used for the treatment of this condition. However, surgery is associated with high mortality rate and many patients have contraindications to thrombolytic therapy and are at high risk for bleeding. Cather-based intervention has gained increasing popularity particularly in patients with contraindication to thrombolytic therapy or at high risk for surgical thrombectomy. Catheter-based thrombus removal can be achieved by many means such as suction, fragmentation, extraction or rheolytic thrombectomy. We present a case of an elderly lady who suffered from acute massive pulmonary embolism with hemodynamic compromise successfully treated with AngioVac catheter system (AngioDynamics, Albany, NY) with full recovery.
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Affiliation(s)
- Ahmed K Pasha
- Department of Internal Medicine, CareMore, Arizona, Tucson, AZ, USA
| | - Mahir D Elder
- Heart and Vascular Institute, 4160 John R, Suite 510, Detroit, MI, USA; Wayne State University/Detroit Medical Center, Detroit, MI 48201, USA
| | - Daniyeh Khurram
- Department of Internal Medicine, Providence Hospital, Southfield, MI, USA
| | | | - Mohammad Reza Movahed
- Department of Internal Medicine, CareMore, Arizona, Tucson, AZ, USA; Sarver Heart Center, University of Arizona, Tucson, AZ, USA; CareMore HealthCare, Tucson, AZ, USA.
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Brown RJ, Uhlman MA, Fernandez JD, Collins T, Brown JA. Novel Use of AngioVac System to Prevent Pulmonary Embolism during Radical Nephrectomy with Inferior Vena Cava Thrombectomy. Curr Urol 2013; 7:34-6. [PMID: 24917754 DOI: 10.1159/000343550] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Accepted: 03/08/2013] [Indexed: 11/19/2022] Open
Abstract
Venous tumor thrombus occurs in 5-10% of patients with renal cell carcinoma. Surgical excision offers the best chance for survival, but is technically difficult. Risk of pulmonary embolism from venous thrombus or tumor thrombus is high, especially with tumors located higher in the inferior vena cava. Cardiopulmonary bypass may be used when a tumor extends above the diaphragm, but carries significant risk. We present an 86-year-old woman with a 7 cm renal mass extending into the inferior vena cava just below the confluence of the hepatic vessels. Prior to surgery she was found to have increasing pulmonary embolisms despite appropriate anticoagulation. Intraoperatively, the AngioVac aspiration system was utilized to prevent further pulmonary embolism. This is the first reported case of the use of this system during radical nephrectomy.
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Affiliation(s)
- Robert J Brown
- Department of Urology, University of Iowa, Iowa City, Iowa, USA
| | | | - Joss D Fernandez
- Department of Cardiothoracic Surgery, University of Iowa, Iowa City, Iowa, USA
| | - Thomas Collins
- Organ Transplant Center, University of Iowa, Iowa City, Iowa, USA
| | - James A Brown
- Department of Urology, University of Iowa, Iowa City, Iowa, USA
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Wunderlich N, Franke J, Sievert H. A novel technique to remove a right atrial thrombotic mass attached to a patent foramen ovale (PFO) closure device. Catheter Cardiovasc Interv 2013:n/a-n/a. [PMID: 23613302 DOI: 10.1002/ccd.24972] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Revised: 03/12/2013] [Accepted: 04/13/2013] [Indexed: 11/12/2022]
Abstract
Any percutaneously implanted foreign device carries the potential risk of thrombus formation. If a thrombus is detected after device implantation during follow-up, in most cases anticoagulation therapy is sufficient to resolve the thrombus. If the anticoagulation concept fails, surgery has been the only alternative option to remove thrombotic masses. This case of a patient with a large thrombus formation attached to a PFO closure device who denied surgery demonstrates that mechanical percutaneous clot retrieval is feasible with the AngioVac aspiration system (Vortex Medical, Inc., Norwell, MA). © 2013 Wiley Periodicals, Inc.
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Affiliation(s)
- N Wunderlich
- CardioVascular Center Frankfurt, Frankfurt, Germany
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