Introducing the use of AngioVac in nonbacterial thrombotic endocarditis: a systematic review

Nonbacterial thrombotic endocarditis (NBTE) involves vegetations on heart valves without active bloodstream infection. The AngioVac device, a vacuum-based aspiration system commonly used for infective endocarditis, has potential in managing NBTE, particularly in patients unsuitable for surgery. This study systematically reviews the literature to evaluate AngioVac’s effectiveness in reducing vegetations in NBTE. A systematic literature review was conducted using PubMed, Embase, Cochrane, and Web of Science databases through February 2024. Primary outcome was procedural success, defined as a ≥ 50% reduction in vegetation size on transesophageal echocardiogram. Secondary outcomes included in-hospital mortality, hospital stay length, and procedural complications. Out of 38 identified articles, 4 case reports met inclusion criteria. Patients were male with a median age of 60 years, and NBTE was associated with conditions such as lung adenocarcinoma, end-stage renal disease, and antiphospholipid syndrome. The mitral valve was the most commonly affected site. AngioVac achieved 100% procedural success, with no complications or in-hospital mortality. The average hospital stay was 2 days. Follow-up revealed one patient alive at 2 months, one deceased at 3 months and no data for two patients. AngioVac is a promising tool for safely reducing vegetations in NBTE, especially for high-risk surgical candidates. The study design and protocol are registered with PROSPERO International Prospective Register of Systematic Reviews (registration number CRD42024505295). Nonbacterial thrombotic endocarditis (NBTE) is a condition where clumps of tissue, called vegetations, form on heart valves without a bacterial infection. The AngioVac device, a tool that works like a vacuum to remove clots and tissue, is commonly used for heart infections and may help treat NBTE in patients who cannot have surgery. This study reviewed past cases to see how effective AngioVac is in removing these vegetations. Several medical databases (PubMed, Embase, Cochrane, and Web of Science) were searched for studies published in February 2024. Cases were included where AngioVac was used on adults with NBTE, and success was defined as a reduction in vegetations by at least 50%. Hospital stays, in-hospital mortality, and any complications were also analyzed in the study. Out of 38 studies, only 4 cases met the criteria. All patients were men, around 60 years old. NBTE was linked to conditions like lung cancer, kidney failure, and a blood-clotting disorder called antiphospholipid syndrome. The vegetations mostly affected the mitral valve. AngioVac successfully reduced the vegetation in all cases, with no complications or deaths in the hospital. The average hospital stay was 2 days. Two-month follow-up showed one patient alive and one deceased, with no data for the others. This study shows that AngioVac is a safe and effective option for treating NBTE, especially for patients at high risk from surgery.