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Multicenter Study
. 2025 Sep 23;86(12):846-856.
doi: 10.1016/j.jacc.2025.06.054. Epub 2025 Aug 27.

Outcomes of Percutaneous Mechanical Aspiration in Right-Sided Infective Endocarditis: A Multicenter Registry

Abdallah El Sabbagh  1 , Benjamin Hibbert  2 , Sripal Bangalore  3 , Pete Fong  4 , David Zlotnick  5 , Bassim El-Sabawi  4 , Robert Zhang  6 , Brittany Zwischenberger  7 , Ahmad Mourad  8 , Leonard Palatnic  5 , Sameh Sayfo  9 , Shenise Gilyard  10 , Stephanie Younes  11 , Ahmad Younes  11 , Joseph Ingrassia  12 , Mohiuddin Cheema  13 , Muhammad Hammadah  14 , Anand Prasad  14 , Nadira Hamid  15 , Konstantinos Voudris  15 , Pedro Villablanca  16 , Amir Kaki  17 , Mohammed Qintar  18 , Zulfiqar Baloch  19 , Marquand Patton  20 , Alejandro Dominguez  20 , Yasir Akhtar  21 , Sidakpal Panaich  22 , Nahyr Lugo-Fagundo  23 , Evin Yucel  24 , David O Hodge  25 , Kenneth Rosenfield  24 , Larry Baddour  26 , Paul Sorajja  15 , John Moriarty  10 , Sahil A Parikh  27 , Sanjum S Sethi  27
Affiliations
Multicenter Study

Outcomes of Percutaneous Mechanical Aspiration in Right-Sided Infective Endocarditis: A Multicenter Registry

Abdallah El Sabbagh et al. J Am Coll Cardiol. .

Abstract

Background: Catheter-based percutaneous mechanical aspiration (PMA) is an emerging acute intervention for debulking infective vegetations in right-sided infective endocarditis (RSIE); however, its outcomes and safety remain undefined.

Objectives: The authors sought to assess early clinical outcomes and safety of PMA in patients with RSIE.

Methods: The CLEAR-IE (Cardiac Lesion Extraction and Aspiration Registry for Infective Endocarditis) is a large multicenter retrospective registry of consecutive patients with RSIE who have undergone PMA. Procedural success was defined as a ≥70% reduction in site-reported vegetation size or a residual size ≤1 cm on intraprocedural echocardiography, which included transesophageal echocardiography (TEE), intracardiac echocardiography (ICE), and transthoracic echocardiography (TTE), selected at the operator's discretion to guide the intervention. The primary endpoint was a composite of in-hospital mortality, new pulmonary embolism (PE), or emergency surgery. Secondary endpoints included each component of the primary endpoint and in-hospital worsening tricuspid regurgitation (TR).

Results: Between January 2014 and January 2024, 256 patients from 19 institutions were included. Median age was 43 years; 43% were women, and 51% had history of injection drug use. Acute PE (50.8%) and shock (27%) were frequent at presentation. Tricuspid valve involvement was present in 70%, with a median site-reported vegetation size of 2.4 cm (Q1-Q3: 0.6-9 cm). Severe TR was noted in 31.3% at baseline. Staphylococcus aureus was the predominant pathogen (73.8%). Procedural success was achieved in 89.4%, with a median residual vegetation size of 0.7 cm (Q1-Q3: 0.2-1.1 cm). Overall, 86.9% completed the procedure free from procedure-related complications. The primary endpoint occurred in 18% (mortality: 9.8%; new PE: 8.3%; emergency surgery: 3.1%). Among those without baseline severe TR, worsening TR occurred in 16.9%. On univariate analysis, shock (OR: 2.27; 95% CI: 1.15-4.43; P = 0.03) and hypoxia (OR: 3.62; 95% CI: 1.83-7.17; P < 0.001) were significantly associated with the primary endpoint, whereas worsening TR was not. On multivariate analysis, hypoxia (OR: 2.76; 95% CI: 1.34-5.73; P = 0.006) remained significantly associated with the primary outcome.

Conclusions: PMA of RSIE is feasible with high procedural success. Adverse events were acceptable and largely driven by underlying RSIE. Randomized trials are warranted to confirm the clinical impact and safety of PMA in RSIE.

Keywords: percutaneous mechanical aspiration; pulmonary embolism; right-sided infective endocarditis; staphylococcus aureus; tricuspid valve; vegetation debulking.

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Conflict of interest statement

Funding Support and Author Disclosures Dr Bangalore serves on advisory boards for Abbott Vascular, Boston Scientific, Biotronik, Amgen, Pfizer, Merck, REATA, Inari, and Truvic. Dr Zlotnick serves on speakers bureaus for Abiomed, Inari Medical, and Angiodynamics; and is a consultant for AngioDynamics. Dr Sayfo is a consultant for Angiodynamic, Inari Medical, Penumbra, Imperative Care, and Boston Scientific. Dr Stephanie Younes serves on the speakers bureau for Angiodynamics. Dr Ahmad Younes serves on the speaker’s bureau for Abbott Laboratories. Dr Hamid consults for Abbott Structural, Anteris, AMX, 4C Medical Technologies, Alleviant Medical, Edwards Lifesciences, Philips, GE, Valcare Med Ltd, Vdyne, and WL Gore. Dr Villablanca is a consultant for Edwards Lifesciences, Medtronic, Angiodynamic, and Abiomed. Dr Patton is a consultant for AngioDynamics. Dr Akhtar has received honoraria and serves on speakers bureaus for AngioDynamics and Penumbra. Dr Rosenfield consults for and/or is on the scientific advisory board member for Althea Medical, Angiodynamics, Boston Scientific, Contego, InspireMD, Magneto, Mayo Clinic, Neptune Medical, Phillips, Summa Therapeutics, Surmodics, Thrombolex, Terumo, and Truvic; holds equity in Accolade, Access Vascular, Aerami, Althea Medical, Contego, Cruzar Systems, Embolitech, Endospan, InspireMD, JanaCare, Magneto, Orchestra, PQ Bypass, Prosomnus, Shockwave, Summa Therapeutics, Thrombolex, Truvic, and Valcare; and serves as board member for National PERT Consortium. Dr Sorajja consults for 4C Medical, Abbott Structural, Adona, Boston Scientific, ConKay, CroiValve, Cultiv8, Edwards Lifesciences, Egg Medical, EvolutionMed, Foldax, GE Medical, Haemonetics, InQ8, LAZA, Medtronic, Phillips, Polares, WL Gore, vDyne, Unorthodox Ventures, Valcare, and xDot; and has received institutional research grants from Abbott, Boston Scientific, Edwards Lifesciences, and Medtronic. Dr Moriarty has received support for the current manuscript from Penumbra; has received consulting fees from AngioDynamics, Innova Vascular, Inquis Medical, Boston Scientific, Imperative Care, and Thrombolex; has received payment or honoraria for lectures, presentations, speaker's bureaus, manuscript writing, or educational events from AngioDynamics and Penumbra; and has stock or stock options from Pavmed and Thrombolex. Dr Parikh has received institutional grants and research support from Abbott Vascular, Shockwave Medical, TriReme Medical, SurModics, Silk Road Medical, and the National Institutes of Health; has received consulting fees from Terumo and Abiomed; and has served on the advisory boards of Abbott, Medtronic, Boston Scientific, CSI, Janssen, and Philips. Dr Sethi has received honoraria from Boston Scientific, Terumo, Inari, Penumbria, Janssen, and Chiesi. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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