Transcatheter Aspiration of Tricuspid Vegetation.

OBJECTIVE

This study sought to present the endovascular approach of transcatheter aspiration using the FlowTriever (Inari Medical) aspiration system for high surgical risk patients with right-sided infective endocarditis.

KEY STEPS: General anesthesia and transesophageal echocardiogram guidance; ultrasonography-guided femoral vein access, preclosure sutures, and insertion of a 24-F sheath; insertion of straight 24-F aspiration cannula over a stiff wire, parked in the superior vena cava; introduction of a 20-F curved cannula inside the 24-F cannula to create a telescopic assembly; accurate positioning using the right ventricle inflow/outflow projection in biplane mode; adjustment of the curved cannula radius by sliding the inner cannula in and out inside the mother cannula; manual aspiration of the vegetation; Postaspiration transesophageal echocardiogram assessment.

POTENTIAL PITFALLS: Avoid leaflet and annular injury and account for potential embolization.

TAKE-HOME MESSAGES: Endovascular aspiration using the aspiration system is an advanced therapeutic approach for high-risk patients with right-sided IE. The aggregative knowledge about transcatheter aspiration of tricuspid vegetation suggests a safe and effective procedural profile.