Percutaneous Mechanical Aspiration Versus Surgical Management of Tricuspid Valve Endocarditis: A Systematic Review and Updated Meta-Analysis.

Tricuspid valve infective endocarditis (TVIE) is increasingly prevalent, especially among intravenous drug users. Surgical intervention is the standard treatment for severe cases, but percutaneous mechanical aspiration (PMA) has emerged as a less invasive alternative in high-risk patients. Comparative data on both strategies remain limited. To evaluate the safety and efficacy of PMA versus surgical management in patients with TVIE through a systematic review and meta-analysis. A comprehensive search of 5 databases (PubMed, Embase, Cochrane, Web of Science, Scopus) through July 2025 identified studies comparing PMA and surgery for TVIE. Outcomes included all-cause mortality (30-day and 1-year), hospital length of stay, in-hospital mortality, and readmission for endocarditis. Risk ratios (RR) and mean differences (MD) were pooled using a random-effects model. Risk of bias was assessed using ROBINS-I. Ten retrospective studies involving 6,035 patients were included (974 treated with PMA and 5,061 treated with surgery). The risk of in-hospital mortality was similar between PMA and surgery (RR = 1.07; p = 0.91). PMA was associated with a higher risk for 30-day mortality (RR = 2.71; 95% CI 1.53 to 4.82; p <0.001) but not for 1-year mortality (RR = 1.13; 95% CI 0.72 to 1.77; p = 0.60) or readmission for endocarditis (RR = 0.82; p = 0.63) compared with surgery. PMA was also associated with a shorter hospital stay (MD = -7.0 days; 95% CI -13.0 to -1.1; p = 0.03). The risk of bias was moderate to serious in all studies. In conclusion, the present systematic review of ten retrospective studies, surgical management of TVIE was associated with better short-term survival compared with PMA although the risks of 1-year mortality and readmission were similar. Randomized trials are required to better define the risk benefit profile of these approaches to TVIE.