800.67 Feasibility And Periprocedural Outcomes of Transcatheter Mass Extraction in Left Heart and Aortic Arch
Recommended Citation
Gregerson S, Fang JX, O'Neill BP, Giustino G, Wang D, Lee JC, Frisoli TM, Engel Gonzalez P, O'Neill WW, VIllablanca PA. 800.67 Feasibility And Periprocedural Outcomes of Transcatheter Mass Extraction in Left Heart and Aortic Arch. JACC Cardiovasc Interv 2024; 17(4):S79.
Document Type
Conference Proceeding
Publication Date
2-1-2024
Publication Title
JACC Cardiovasc Interv
Abstract
Background: Transcatheter vacuum-assisted mass extraction (TVME) is an alternative to surgical thrombectomy in high-risk patients especially for right-sided heart chambers. TVME in the left heart is less frequently performed owing to the need for transeptal puncture or alternative access, and the potential need for embolic protection, and the higher risk of blood loss. We report a case series of left-sided TVME at a high-volume center in USA. Methods: We performed left sided TVME in 24 consecutive patients from January 2019 to July 2023 at Henry Ford Hospital, MI, USA. The AngioVAC (Angiodynamics Inc, USA) was used. The preferred placement location for the blood return cannula was into the arterial system. Large bore access and closure were performed with standard techniques. TVME was performed for mass in the left atrium in 3 patients, left atrial appendage in 9 patients, left ventricle in 7 patients, aortic arch in 5 patients. Transeptal puncture was performed in all cases of left atrial and left ventricular masses. Transcaval access was performed in 4 out of 5 cases of aortic arch masses in order to gain enough catheter reach. Embolic protection device was used in 20 out of 24 patients. Concurrent left-atrial appendage occlusion was done in 5 patients with left-atrial appendage thrombus and concurrent balloon mitral valvuloplasty in two patients. Procedural success was defined as debulking of the total mass volume by 70% or more on echocardiogram. Results: The mean age of the patients was 59. Half were male. Mean left ventricular ejection fraction was 45%. The mean diameter of the mass was 3.2 cm. The procedure was completed in 96% (23 out of 24) of cases and aborted in 1 case. Successful debulking was achieved in 79% of cases. The median procedure time was 186 minutes. The mean procedural blood loss was 161 ml. The return cannula was placed on the arterial side in 66.6% (16 out of 24) of cases and on the venous side in 33.3% (8 out of 24) of cases. Periprocedural complications were uncommon. One patient developed stroke. One patient developed retroperitoneal bleeding. One patient developed a right femoral pseudoaneurysm. 2 patients required blood transfusion periprocedurally. The median length of hospitalization was 10 days. All patients were discharged alive from the hospital. Conclusions: TVME is technically feasible and safe for left-sided and aortic arch lesions.
Volume
17
Issue
4
First Page
S79
