Outcomes of percutaneous vacuum‐assisted debulking of large vegetations as an adjunct to lead extraction

Kiani, Soroosh; Sabayon, Dean; Lloyd, Michael S.; Hoskins, Michael; El‐Chami, Mikhael F.; Westerman, Stacy; Vadlamudi, Ratna K.; Keeling, Brent; Lattouf, Omar M.; Merchant, Faisal M.

doi:10.1111/pace.13726

Cited by 9 publications

(9 citation statements)

References 23 publications

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“…Suction should be turned off when blood flow to the vacuum canister resumes. The published data on success rates of thrombus removal using the Angiovac system is limited to case reports comparable in size to this one 4,7,17–20 . The amount of data available is not sufficient to compare the outcomes with the two techniques.…”

Section: Discussionmentioning

confidence: 94%

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Use of a clot aspiration system during transvenous lead extraction

Richardson

Lugo

Crossley

et al. 2020

Cardiovasc electrophysiol

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Introduction The optimal approach to the extraction of leads with large vegetations remains uncertain. Methods High‐risk patients with lead associated vegetations undergoing device extraction at Vanderbilt Hospital with concomitant use of the Penumbra Aspiration System (Penumbra Inc, Alameda, CA) are described. An 8.5 Fr Agilis NXT (Abbott Inc, St. Paul, MN) was advanced to the right atrium, through which a Penumbra Indigo Cat‐8 catheter was advanced. Using intracardiac echocardiography, the Penumbra was positioned directly on the vegetation, suction was applied until adherent, and the Indigo catheter and Agilis sheath were then removed en‐bloc and aspirated debris flushed out. This was repeated until debulking was considered successful. Results Eight cases were performed. The median vegetation size was 2 cm. Pathogens were Enterococcus, Staphylococcus, Candida, Cutibacterium, and Enterobacter. In seven of eight cases, aspiration successfully reduced vegetations to less than 1 cm before successful percutaneous cardiac implantable electronic device removal. One patient underwent surgical removal via thoracotomy. There were no acute complications related to the Penumbra catheter. Three patients had CT evidence of small pulmonary emboli postprocedure. The length of stay was 3 to 27 days. One patient died on POD 1 of refractory ventricular tachycardia unrelated to the procedure. One patient died of ongoing sepsis 2 weeks postextraction. Conclusions The Penumbra Indigo Aspiration system can be useful for vegetation debulking before transvenous lead extraction.

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Section: Discussionmentioning

confidence: 94%

“…The published data on success rates of thrombus removal using the Angiovac system is limited to case reports comparable in size to this one. 4,7,[17][18][19][20] The amount of data available is not sufficient to compare the outcomes with the two techniques. likely better approached with the Angiovac system.…”

Section: Discussionmentioning

confidence: 99%

Use of a clot aspiration system during transvenous lead extraction

Richardson

Lugo

Crossley

et al. 2020

Cardiovasc electrophysiol

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“…Surgical lead extraction is recommended for cases with lead vegetations larger than 2.5 cm 4 . Recently, debulking large lead vegetations using a vacuum catheter system has been attempted 10 . The indication for surgical lead extraction might change in the future.…”

Section: Discussionmentioning

confidence: 99%

Transvenous lead extraction versus surgical lead extraction or conservative treatment for cardiac implantable electronic device infections: Propensity score‐weighted analyses of a nationwide claim‐based database

Wada

Inoue

Nakai

et al. 2023

Pacing Clinical Electrophis

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IntroductionInfection is one of the most important complications associated with cardiac implantable electronic device (CIED) therapy. The number of reports comparing the outcomes of transvenous lead extraction (TLE), surgical lead extraction, and conservative treatment for CIED infections using a real‐world database is limited. This study investigated the association between the treatment strategies for CIED infections and their outcomes.MethodsWe performed a retrospective analysis of 3605 patients with CIED infections admitted to 681 hospitals using a nationwide claim‐based database collected between April 2012 and March 2018.ResultsWe divided the 3605 patients into TLE (n = 938 [26%]), surgical lead extraction (n = 182 [5.0%]), and conservative treatment (n = 2485 [69%]) groups. TLE was performed more frequently in younger patients and at larger hospitals (p for trend < .001 for both). The rate of TLE increased during the study period, whereas that of surgical lead extraction decreased (p for trend < .001 for both). TLE was associated with lower in‐hospital mortality (vs. surgical lead extraction: odds ratio [OR], 0.20; 95% CI, 0.06–0.70; vs. conservative treatment: OR, 0.45; 95% CI: 0.22–0.94) and lower 30‐day readmission rates (vs. surgical lead extraction: OR, 0.18; 95% CI: 0.06–0.56; vs. conservative treatment: OR, 0.06; 95% CI, 0.03–0.13) in propensity score‐weighted analyses.ConclusionsOnly 26% of patients hospitalized for CIED infections received TLE. TLE was associated with significantly lower in‐hospital mortality and 30‐day recurrence rates than surgical lead extraction and conservative treatment, suggesting that TLE should be more widely recommended as a first‐line treatment for CIED infections.

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“…Although a clear benefit of vacuum-assisted debulking of lead vegetations over a conventional percutaneous extraction has not yet been proven [ 9 ], the preliminary results of the AngioVac system for the aspiration of intracardiac masses are promising [ 16 ]. Successful removal rates vary depending on the specific origin and location of the mass, ranging between 60 and 80% in larger registries and series [ 16 , 31 ].…”

Section: Discussionmentioning

confidence: 99%

“…The AngioVac system (AngioDynamics, Latham, NY, USA) is a novel percutaneous technology that includes an aspiration cannula combined with a filter, a centrifugal pump, and a venous or arterial reinfusion cannula, intended for the intravascular aspiration of right-sided masses. This device has found an application for CDRIE vegetations debulking before lead extraction [ 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 ]. A systematic review of literature by Rusia et al in 2019 collected a total of 88 patients in whom this device has been successfully adopted to treat CDRIE in 97.7% of cases [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

Vacuum-Implemented Removal of Lead Vegetations in Cardiac Device-Related Infective Endocarditis

Tarzia

Ponzoni

Evangelista

et al. 2022

JCM

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When approaching infected lead removal in cardiac device-related infective endocarditis (CDRIE), a surgical consideration for large (>20 mm) vegetations is recommended. We report our experience with the removal of large CDRIE vegetations using the AngioVac system, as an alternative to conventional surgery. We retrospectively reviewed all infected lead extractions performed with a prior debulking using the AngioVac system, between October 2016 and April 2022 at our institution. A total of 13 patients presented a mean of 2(1) infected leads after a mean of 5.7(5.7) years from implantation (seven implantable cardioverter-defibrillators, four cardiac resynchronization therapy-defibrillators, and two pacemakers). The AngioVac system was used as a venous–venous bypass in six cases (46.2%), venous–venous ECMO-like circuit (with an oxygenator) in five (38.5%), and venous–arterial ECMO-like circuit in two cases (15.4%). Successful (>70%) aspiration of the vegetations was achieved in 12 patients (92.3%) and an intraoperative complication (cardiac perforation) only occurred in 1 case (7.7%). Subsequent lead extraction was successful in all cases, either manually (38.5%) or using mechanical tools (61.5%). The AngioVac system is a promising effective and safe option for large vegetation debulking in CDRIE. Planning the extracorporeal circuit design may represent the optimal strategy to enhance the tolerability of the procedure and minimize adverse events.

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Outcomes of percutaneous vacuum‐assisted debulking of large vegetations as an adjunct to lead extraction

Cited by 9 publications

References 23 publications

Use of a clot aspiration system during transvenous lead extraction

Use of a clot aspiration system during transvenous lead extraction

Transvenous lead extraction versus surgical lead extraction or conservative treatment for cardiac implantable electronic device infections: Propensity score‐weighted analyses of a nationwide claim‐based database

Vacuum-Implemented Removal of Lead Vegetations in Cardiac Device-Related Infective Endocarditis

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