Vacuum-assisted thrombectomy for intracardiac and intravascular thrombi: A single-center experience.

OBJECTIVE

Percutaneous vacuum-assisted mechanical thrombectomy using venovenous bypass is a potential alternative to open surgery for the removal of intracardiac and intravascular/caval thrombi. We sought to evaluate the unique role and efficacy of this procedure in the treatment of high-risk patients deemed poor candidates for surgical thrombectomy.

METHODS

Between May 2015 and October 2023, 40 patients underwent vacuum-assisted thrombectomy for intracardiac or caval thrombi using venovenous bypass at our medical center. Patient and case characteristics, procedural details, and postprocedural outcomes were collected retrospectively. All procedures involved a multidisciplinary approach by cardiac surgeons, interventional radiologists, and cardiac anesthesiologists. Cardiac electrophysiologists also participated in the procedures when patients needed concomitant cardiovascular implantable electronic device system extractions.

RESULTS

Mean age of patients was 50 ± 16 years. Indications included indwelling catheter thrombus (n = 10; 25%), cardiovascular implantable electronic device infection (n = 12, 30%), tricuspid endocarditis (n = 8, 20%), and bland and tumor thrombus (n = 11, 28%, n = 7, 18%, respectively). Successful removal rate (>70% of thrombus removed) was 85% (n = 34). Interventional adjuncts included cardiovascular implantable electronic device lead extraction (n = 10, 25%) and snaring from contralateral access site (n = 7, 18%). In-hospital and 30-day mortality were 5% (n = 2) and 8% (n = 3), respectively. Complications included postoperative red blood cell transfusion (n = 5, 13%), pulmonary embolism (n = 2, 5%), and recurrent thrombosis (n = 2, 5%). Median total follow-up time was 16 ± 3 months, with either complete resolution or decreased burden of residual thrombus.

CONCLUSIONS

Vacuum-assisted thrombectomy is a rapid, effective, and safe technique when treating critically ill patients with acute intracardiac and caval thrombi and vegetation. It can be a highly valuable adjunct when treating poor candidates for open cardiovascular surgery.