Percutaneous Debulking of Left Atrial Appendage Occlusion Device-Associated Thrombi and Vegetation

Background: The incidence of prosthetic device endocarditis has increased with the emergence of percutaneous modalities used for the treatment of structural heart disease. The AngioVac mechanical aspiration system has been used to percutaneously debulk native valve, prosthetic valve, and prosthetic device-associated thrombi as well as vegetations in the setting of endocarditis. However, there are limited descriptions of its use in left-sided prosthetic device-associated infected thrombi and vegetation. Case Summary: We describe 2 patients who underwent successful percutaneous debulking of left atrial appendage occlusion device-associated thrombi and vegetation in the setting of refractory infective endocarditis with the AngioVac mechanical aspiration system. Discussion: Minimally invasive thrombectomy/debulking with the AngioVac system appears to be a safe and effective alternative to cardiac surgery for the management of high-risk patients with left-sided intracardiac thrombi. Take-Home Messages: Patients with left atrial appendage occlusion device implantation may be at risk for device-associated thrombus in the setting of infective endocarditis. Percutaneous thrombectomy with the AngioVac mechanical aspiration system may be a safe and effective alternative to cardiac surgery for the management of high-risk patients with left-sided intracardiac thrombi.