# Percutaneous Vegetectomy for Infective Endocarditis in a Nonsurgical Candidate

## TL;DR

This paper presents a case where a minimally invasive AngioVac procedure was used to treat infective endocarditis in a patient who could not undergo surgery.

## Contribution

The paper introduces percutaneous vegetectomy as a viable alternative for treating infective endocarditis in nonsurgical candidates.

## Key findings

- The AngioVac system was successfully used in a patient with persistent bacteremia and tricuspid valve endocarditis.
- Percutaneous aspiration can be a treatment option when surgical intervention is not feasible.
- The procedure is suitable for patients with large vegetations and poor surgical candidacy.

## Abstract

Surgical management is recommended for infective endocarditis (IE) when there is right heart failure due to severe tricuspid regurgitation, recurrent septic pulmonary emboli, persistent bacteremia, and large tricuspid valve vegetations (≥20 mm). However, sternotomy comes with strict eligibility limitations, including poor functional status, respiratory failure, and recent intravenous drug use.

A 55-year-old woman with a history of intravenous drug use was diagnosed with persistent bacteremia in the setting of tricuspid valve endocarditis. Poor surgical candidacy prompted consideration of less invasive alternatives, including percutaneous aspiration.

This case highlights the viability of AngioVac vegetectomy as an alternative treatment modality for persistent IE in poor surgical candidates.

Surgical intervention is considered for right-sided native valve IE with vegetations ≥20 mm, persistent bacteremia, recurrent pulmonary septic emboli, or highly resistant organisms. The AngioVac system provides a minimally invasive treatment strategy for IE in patients who are otherwise ineligible for surgical intervention.