Abstract Body (Do not enter title and authors here): Background

The AngioVac mechanical aspiration system has recently emerged in the literature for its use in the percutaneous debulking of intracardiac vegetations and masses. However, description of its efficacy in the setting of vegetation size stratification has remained sparse. We present our unique experience with the AngioVac system in patients with tricuspid valve infective endocarditis (TVIE) and high or prohibitive operative risk with a vegetation size ≥ 2cm compared to a vegetation size of < 2cm.

Methods
We performed a retrospective, in-hospital, comparative analysis on all patients who underwent percutaneous AngioVac vegetation debulking in the setting of TVIE with a vegetation size ≥ 2cm compared to a vegetation size < 2cm from January 2017 to December 2023 at a large academic tertiary care hospital.

Results
Of the 62 patients who underwent AngioVac debulking, 56 patients had the size of the vegetation described on echocardiography and were included. 35 patients had a vegetation size ≥ 2cm and underwent AngioVac debulking. 17 (48.6%) were women and mean age was 39.192 +/- 12.186 years. 21 patients had a vegetation size < 2cm and underwent AngioVac debulking. 10 (47.6%) were women and mean age was 38.508 +/- 12.056 years. During their index admission, between patients with a vegetation size < 2cm compared to ≥ 2cm, there was no difference in time (days) from procedure to blood culture clearance (P-value: 0.171, 95% CI: -1.178 – 6.360). There was no difference in the risk of stroke (P-value: 0.517, 95% CI: 0.000-8.792), or blood transfusion requirement (P-value 0.011, 95% CI: 0.039 – 0.757). There was no difference in the risk of experiencing worsening tricuspid regurgitation post-procedure (OR: 0.211, 95% CI: 0.004 – 1.884) or risk of recurrent endocarditis (OR: 0.778, 95% CI: 0.104 – 4.634). Finally, there was no difference in the length of hospital stay (days) between both groups (P-value: 0.234, 95% CI -4.966 – 19.758), and there was no difference in in-hospital mortality post-procedure (P-value: 0.626, 95% CI: 0.116 – 25.524). Notably, neither of the two groups required surgical or percutaneous tricuspid valve replacement.

Conclusion
This retrospective, comparative analysis adds to the growing literature that Angiovac debulking may be a safe and effective long-term alternative to cardiac surgery in patients with TVIE and elevated perioperative risk, irrespective of vegetation size.