# Mechanical Debridement of Methicillin-Sensitive Staphylococcus aureus Endocarditis: A Novel Approach Using Percutaneous Aspiration

## TL;DR

A new minimally invasive technique using percutaneous aspiration helps treat severe right-sided infective endocarditis when surgery is not an option.

## Contribution

The AngioVac system is presented as a novel, minimally invasive treatment for right-sided endocarditis in high-risk patients.

## Key findings

- Percutaneous aspiration with the AngioVac system significantly reduced vegetation size and improved clinical outcomes.
- The procedure stabilized the patient's condition and allowed for successful continuation of antimicrobial therapy.
- AngioVac shows promise as an alternative to surgery for complex endocarditis cases.

## Abstract

Infective endocarditis (IE) remains a serious and potentially fatal diagnosis with substantial morbidity, particularly when involving large right-sided vegetations or occurring in patients who are poor candidates for surgical intervention. Despite advancements in antimicrobial therapy and diagnostic imaging, management of these complex cases continues to pose significant clinical challenges. The AngioVac aspiration system (AngioDynamics, Inc., Latham, New York, United States) has emerged as a minimally invasive option capable of percutaneously removing intracardiac vegetations, thrombi, or infected material while maintaining hemodynamic stability through extracorporeal filtration and reinfusion. By reducing overall bacterial burden and mitigating the inoculum effect, this technique can enhance antibiotic efficacy, decrease the risk of septic embolization, and serve as a valuable bridge or alternative to surgery. We describe a case of severe right-sided IE complicated by persistent methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia, septic pulmonary emboli, and multivalvular involvement in a young patient with significant clinical deterioration despite broad-spectrum antimicrobial therapy. Owing to prohibitive surgical risk, percutaneous vegetation debulking with the AngioVac system was pursued under transesophageal echocardiographic guidance. The procedure achieved a substantial reduction of vegetation size with immediate clinical and microbiologic improvement. Following AngioVac intervention, the patient demonstrated clearance of bacteremia, stabilization of respiratory status, and eventual recovery with continued targeted antimicrobial therapy. This case highlights the expanding role of AngioVac as an important therapeutic adjunct in select patients with right-sided IE, especially when conventional surgical management is not feasible. Continued reporting of such cases will help refine patient selection, procedural indications, and long-term outcomes for this evolving treatment modality.