Transcatheter Aspiration of Tricuspid Vegetation

Overview

Journal JACC Case Rep

Date 2025 Jan 17

PMID 39822638

Authors

Akiva Brin

Danny Dvir

Emanuel Harari

Shemy Carasso

Yonit Wiener-Well

Michael Glikson

Tal Hasin

Affiliations

Soon will be listed here.

Abstract

Objective: This study sought to present the endovascular approach of transcatheter aspiration using the FlowTriever (Inari Medical) aspiration system for high surgical risk patients with right-sided infective endocarditis.

Key Steps: General anesthesia and transesophageal echocardiogram guidance; ultrasonography-guided femoral vein access, preclosure sutures, and insertion of a 24-F sheath; insertion of straight 24-F aspiration cannula over a stiff wire, parked in the superior vena cava; introduction of a 20-F curved cannula inside the 24-F cannula to create a telescopic assembly; accurate positioning using the right ventricle inflow/outflow projection in biplane mode; adjustment of the curved cannula radius by sliding the inner cannula in and out inside the mother cannula; manual aspiration of the vegetation; Postaspiration transesophageal echocardiogram assessment.

Potential Pitfalls: Avoid leaflet and annular injury and account for potential embolization.

Take-home Messages: Endovascular aspiration using the aspiration system is an advanced therapeutic approach for high-risk patients with right-sided IE. The aggregative knowledge about transcatheter aspiration of tricuspid vegetation suggests a safe and effective procedural profile.

References

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