Risk Stratification of Incomplete Intracardiac or Intravascular Mass Aspiration with a Percutaneous Aspiration System

Background: In recent years, percutaneous aspiration systems based on an extracorporeal circuit with an in-line filter were increasingly used for intravascular mass aspiration. Indications were central venous as well as right heart thrombi and vegetations. While reported success rates between 60 and 75% of complete mass removal are encouraging, in some cases mainly incomplete mass removal or less often failed aspiration were described. So far, factors for aspiration success based on a mass characterization and procedural characteristics are missing.

The aim of this study is to identify factors associated with incomplete mass removal or complete procedural failure based on vegetation or thrombus characteristics.

Method: We retrospectively analyzed all percutaneous mass aspiration procedures in our center between June 2015 and July 2022. The targeted mass of each procedure was characterized by its size, constitution, localization, age and its association with leads or catheters. The operative approach was characterized by anticoagulation, its procedure and perfusion times, and cannulation sites.

Results: Between June 2015 and July 2022, a total of 144 patients (90 [62.5%] male) were included in the analysis. In 113 patients, complete procedural success (CPS) was observed, whereas in 31 patients an incomplete aspiration or a procedural failure (IA/PF) was observed. Vegetations are more likely to be removed than thrombi (CPS: 88/113 (77.9%) versus IA/PF: 17/31 (54.8%), p = 0.01). The age of the targeted mass has a highly significant negative impact on procedural success (4.7 ± 5.7 weeks in the CPS group vs. 11 ± 15 weeks in the IA/PF group, p = 0.001). In terms of localization, in the majority of cases with IVC (CPS: 4/113 [3.5%] vs. IA/PF: 7/31 [22.6%], p ≤ 0.001) or tricuspid valve (CPS: 9/113 [8%] vs. IA/PF: 8/31 [25.8%], p = 0.006) masses, they were reduced in size without complete removal. In association with CIED leads and concomitant lead extraction, right atrial masses are more likely to be completely removed (CPS: 96/113 [85%] vs. IA/PF: 20/31 [64.5%], p = 0.01).

Conclusion: This investigation stratifies between detailed mass characteristics and their probability to be aspirated by a percutaneous aspiration system. Reduced rates of complete mass removal were found in patients with chronic thrombi or vegetations as well as IVC thrombotic occlusion. Large (>1 cm) right-atrial lead-associated vegetations are associated with the highest rates of complete procedural success.

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Artikel online veröffentlicht:
28. Januar 2023