Novel approach of Angiovac in difficult to treat right sided Infective Endocarditis cases, an experience at tertiary care center.

Background: The AngioVac Cannula (AngioDynamics, Latham, NY, USA) is a vacuum-based drainage device introduced in 2012 to remove undesirable foreign material in the intravascular system. It has been used to remove debris from the vena cavae, the iliac veins, and the right atrium. In some case reports, AngioVac has been used for removal of device lead vegetations and right-sided endocardial vegetations. Cases considered for open surgical vegectomy can be considered for AngioVac application. Use of this device shows benefit as a minimally invasive alternative to surgery in reducing vegetation load, which can facilitate valve replacement, can reduce septic lung embolization and prolonged persistent bactremia while on appropriate antibiotics.

Methods: In our series, we describe three cases of right-sided endocarditis treated with AngioVac at our medical center.

Results: In case 1, a 35 year old man admitted with methicillin-susceptible Staphylococcus aureus bacteremia and septic shock after a mobile 4.5 cm mass was noted extending from the superior vena cava into the right atrium, and traversing the tricuspid valve during diastole. This mass was removed with AngioVac and later confirmed as vegetation. In case 2, a 28 year-old woman with a history of IV heroin use presented with methicillin-resistant Staphylococcus aureus bacteremia and resulting septic shock. Trans-esophageal echocardiogram confirmed tricuspid vegetations on the anterior and posterior leaflets that were larger than prior causing tricuspid regurgitation and septic pulmonary emboli. AngioVac was used to remove the vegetations despite being on appropriate antibiotics for 20 days. In case 3, a 58 year-old woman with a recently placed bioprosthetic tricuspid valve and IV heroin use was admitted to the hospital with Enterococcus faecalis bacteremia, a 3.2 cm tricuspid valve vegetation, and resulting moderate tricuspid regurgitation. The AngioVac was used to debulk this vegetation, with resulting improvement in tricuspid regurgitation.

Conclusion: These cases the promise of the AngioVac as a new approach in endocarditis treatment, providing an alternative to open surgery and as an accessory to antimicrobial treatment.