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 gender-related outcomes and analysis has remained sparse. We present our unique experience with the AngioVac system in men compared to women with tricuspid valve infective endocarditis (TVIE) and high or prohibitive operative risk.

Methods
We performed a retrospective, in-hospital analysis comparing all men and women who underwent percutaneous AngioVac vegetation debulking in the setting of TVIE from January 2017 to December 2023 at a large academic tertiary care hospital.

Results
Of the 62 patients who underwent AngioVac debulking between January 2017 and December 2023, 32 (51.6%) were women with a mean age of 35.921 +/- 9.976 years. The mean length of the vegetation was 19.581 +/- 7.478 mm and time (days) to blood culture clearance was 8.667 +/- 7.799. Of the 62 patients, 30 (48.4%) were men with a mean age of 41.711 +/- 13.627 years. The mean length of the vegetation was 21.759 +/- 7.836 mm, and time (days) to blood culture clearance was 6.188 +/- 3.692. During their index admission, between both men and women, there was no difference in time (days) from procedure to blood culture clearance (P-value: 0.239, 95% CI: -6.717 – 1.758). There was no difference in the risk of stroke (P-value 0.489, 95% CI: 0.00 – 5.852), systemic embolism (P-value: 0.577, 95% CI: 0.124 – 164.863), vascular access bleeding (OR: 0.966, 95% CI: 0.011 – 78.416), or blood transfusion requirement (P-value 0.799, 95% CI: 0.270 – 2.622). There was no difference in risk of recurrent endocarditis (P-value: 0.712, 95% CI: 0.265 – 9.147) or worsening tricuspid regurgitation post-procedure (P-value: 0.470, 95% CI: 0.075 – 3.113). Finally, there was no difference in the length of hospital stay (days) between both groups (P-value: 0.990, 95% CI: -11.748 – 11.605), and there was no difference in in-hospital mortality post-procedure (P-value: 0.354, 95% CI: 0.384 – 218.472). 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 both men and women with TVIE and elevated perioperative risk.