Po-02-046 concomitant transcatheter debulking of right heart vegetations during extraction of transvenous device system for endocarditis: a four case series

Right heart infective endocarditis (IE) is a rare but serious complication of permanent transvenous pacing. Surgical intervention is often necessary for large vegetations or when bacteremia persists despite antibiotics in addition to extraction of transvenous pacing system. To evaluate outcomes of patients who underwent transcatheter debulking of IE-related right heart vegetations in the setting of a transvenous device endocarditis. Patients with right heart vegetations from IE in the setting of transvenous devices who were deemed poor surgical candidates at a single-center were included in this analysis. Vegetations were debulked using the LightningTM system with the CAT12TM catheter from a femoral approach with intracardiac echocardiography guidance. Intra and post-procedural outcomes were recorded. Four patients with a median age of 58 years, 50% male, with varying types of bacteremia (Enterococcus faecalis (2), methicillin-sensitive Staphylococcus aureus, and Streptococcus agalactiae) and associated TV and/or lead vegetations were included. Vegetations were located on the TV (2), right atrial lead (4), and right ventricular lead (2). The largest vegetation in this series was 3.4cm by 1.75cm with a volume of 5.14 cm3 and the smallest was 1.1cm by 0.9cm with a volume of 0.47 cm3. All patients had substantial vegetation burden causing clinically significant valve dysfunction. The vegetations were successfully debulked in all four cases. Post-procedure imaging in all four patients showed at least a 75% reduction in vegetation burden. All patients successfully underwent extraction of their transvenous pacing systems as well. All patients tolerated their procedures well and remained free of infection at follow-up after completing a 6-week course of intravenous antibiotics. There were no procedure-related adverse events recorded within 30 days of intervention. Right heart vegetation debulking with a thrombus aspiration catheter is a potential alternative in patients with device infection and large vegetations who are not candidates for surgical intervention. Additional studies are needed to understand the long-term implications of this intervention in this high-risk population.