Early outcomes of transcatheter vacuum-assisted mass extraction in the left heart and the aortic arch.

BACKGROUND

Transcatheter vacuum-assisted mass extraction (TVME) in the systemic circulation is increasingly being reported. However, its feasibility, effectiveness, and safety remain poorly defined.

AIMS: We sought to investigate the feasibility, effectiveness and safety of TVME in the left heart and aortic arch.

METHODS

Consecutive patients from 6 centres in the United States and Canada were included. Feasibility was defined as technically successful mass extraction without unplanned cardiac surgery or intraprocedural mortality. The effectiveness endpoint was feasibility with successful debulking of ≥70% mass volume. The primary safety endpoint was the 30-day composite of procedure-attributable mortality, major cardiac structural complications, major vascular complications, Type 3-4 bleeding, acute coronary syndrome (ACS), and stroke, all according to Valve Academic Research Consortium (VARC)-3 definitions. Intraprocedural events were also reported.

RESULTS

A total of 62 consecutive patients were evaluated. Feasibility was reached in 85.5% of patients and effectiveness in 77.4% of patients - except for 11.3% with suboptimal debulking, 3.2% with access-related case abortion, and 8.1% with case cancellation where no mass was found intraprocedurally. The primary safety endpoint occurred in 14.5% of patients, with a procedure-attributable mortality rate of 3.2%. VARC-3 major cardiac structural complications, major vascular complications, Type 3-4 bleeding, ACS, and stroke occurred in 3.2%, 8.1%, 3.2%, 3.2%, and 6.5% of patients, respectively. Intraprocedural events included hypoxia (6.5%), hypotension (9.7%), embolism (3.2%), air embolism (1.6%), and increased mitral regurgitation (6.5%).

CONCLUSIONS

TVME in left-sided and aortic arch masses is feasible and demonstrates reasonable effectiveness. However, the considerable rate of safety-related events highlights the need for better case selection and procedural refinement, such as optimal embolic protection.