TCT-663 Device-Specific Outcomes of Percutaneous Mechanical Aspiration in Right-Sided Infective Endocarditis: Insights from the CLEAR-IE Registry
Recommended Citation
Robinson G, Heybati K, Hibbert B, Bangalore S, Fong P, Zlotnick D, El-Sabawi B, Zhang R, Zwischenberger B, Palatnic L, Sayfo S, Gilyard S, Younes S, Younes A, Ingrassia J, Prasad A, Hamid N, Voudris K, Villablanca P, Kaki A, Qintar M, Baloch ZQ, Patton M, Dominguez A, Akhtar Y, Panaich S, Lugo-Fagundo N, Yucel E, Baddour L, Sorajja P. TCT-663 Device-Specific Outcomes of Percutaneous Mechanical Aspiration in Right-Sided Infective Endocarditis: Insights from the CLEAR-IE Registry. J Am Coll Cardiol 2025; 86(17):B289.
Document Type
Conference Proceeding
Publication Date
10-28-2025
Publication Title
J Am Coll Cardiol
Abstract
Background: Multiple aspiration devices have been used for percutaneous mechanical aspiration (PMA) in right-sided infective endocarditis (RSIE); however, the impact of device-specific characteristics on procedural outcomes remains unclear. Methods: This is an analysis of the CLEAR-IE (Cardiac Lesion Extraction and Aspiration Registry for Infective Endocarditis), a registry of adults with RSIE who underwent PMA from January 2014 to January 2024. Patients were stratified by aspiration technique: continuous-flow (CF) or non-continuous-flow (NCF). Procedural success was defined as ≥70% reduction in vegetation size or residual vegetation ≤1 cm. The primary endpoint was a composite of in-hospital death, new pulmonary embolism, worsening tricuspid regurgitation, or emergency surgery. Secondary endpoints included individual components of the primary outcome and blood loss. Logistic regression and survival analysis were performed. Results: Of 238 patients (median age 43 years, 44.1% female), CF-PMA was used in 202 (84.9%) and NCF-PMA in 36 (15.1%). CF-PMA patients were younger (42 vs. 59.5 years; p=0.004), had higher rates of IV drug use (54% vs. 28.6%; p=0.006), pulmonary embolism (56.4% vs. 30.6%; p=0.004), and persistent sepsis (65.8% vs. 40%; p<0.001). NCF-PMA patients had more atrial fibrillation (36.1% vs. 14.5%; p=0.002), cardiovascular implantable electronic devices (66.7% vs. 19.9%; p<0.001), and lead-related vegetations (54.5% vs. 18.3%; p<0.001). Vegetation size was similar (23 mm vs. 26 mm; p=0.69). Procedural success was similar (87% vs. 97.1%; p=0.091), though, CF-PMA was associated with smaller residual vegetations (0.68 cm vs. 0.95 cm; p=0.005). There was no difference in primary endpoint events (27.2% vs. 30.6%; p=0.68), though CF-PMA had less blood loss (median 50 mL [IQR 50-100] vs. 150 mL [IQR 50-150]; p=0.037). Six-week survival was similar. Conclusion: Both CF and NCF PMA techniques demonstrated high procedural success with comparable rates of adverse events. Differences in baseline patient characteristics may have influenced device selection, and NCF systems were associated with greater blood loss. Prospective studies are needed to confirm these findings and guide optimal device selection. Categories: STRUCTURAL: Valvular Disease and Intervention: Tricuspid
Volume
86
Issue
17
First Page
B289
