Non-surgical Treatment of Large Tricuspid Valve Vegetations

Over the past 20 years, the incidence of right-sided infective endocarditis has been steadily rising, largely in part due to the opioid epidemic. Although intravenous antibiotics remain a mainstay of therapy, complications related to the underlying infection often render medical therapy alone ineffective. In this setting, surgical intervention has traditionally been pursued for definitive management. Unfortunately, a large proportion of this cohort has a prohibitive risk for conventional surgery, highlighting the need for alternate treatment modalities. Using its proprietary FDA-approved technology, AngioVac (Angiodynamics, Latham, NY USA) can effectively debulk large vegetations, thereby helping improve the response to intravenous antibiotics and averting sequelae related to distal embolization of infectious material. In the setting of lead infections, concomitant use of AngioVac can help facilitate percutaneous lead extraction and thereby avoid the need for surgical intervention. This chapter outlines the rationale, patient selection, evidence, and procedural steps of the AngioVac in right-sided infective endocarditis.