Dec. 21, 2024
A rise in right-sided infective endocarditis in the United States is driving cardiovascular specialists to find novel solutions. Factors affecting the change include the IV drug use epidemic, an increase in cardiac implantable devices and patients with comorbid conditions.
Mayo Clinic interventional cardiologists guided a new catheter-based approach to treat patients with right-sided infective endocarditis without surgery. A Mayo Clinic-led study across 19 U.S. sites included patients who were not good candidates for surgery and whose heart infection did not clear up with antibiotic use. The late-breaking research findings were recently presented at the Transcatheter Cardiovascular Therapeutics annual meeting.
The study shows that the minimally invasive catheter-based aspiration of the infection is feasible and successful for those with no alternative therapeutic options. Of the participants, more than 90% had their infection cleared, and hospital mortality was lower. The catheter method made a difference in helping a patient's response to antibiotic therapy afterward.
"This is a new approach to removing heart infection without surgery. Mayo Clinic experts pioneered endocarditis aspiration techniques used in this method," says Abdallah El Sabbagh, M.D., an interventional cardiologist at Mayo Clinic in Jacksonville, Florida. "The finding that heart infections can be removed without surgery is extremely important for patient care. It provides a catheter-based option for patients with persistent infection who are at high risk of surgery and are not responding to antibiotics alone."
Risk of septic spread
Patients who have undergone a transplant or cancer treatment and have weakened immune systems are more susceptible to infections. If not treated quickly, infections can grow and damage heart valves and other organs. When an infection is inside a heart valve, patients with high surgical risk often have few therapeutic options.
"Infective endocarditis occurs because a bug, usually bacteria, adheres to a cardiac structure such as a valve or a device, and forms a layer of clot that makes it avoid the immune system," says Dr. El Sabbagh. "It then causes persistent infection as well as dislodgement of the infective material into the lungs, causing septic pulmonary emboli, which damages the lungs."
Research meets patients' needs
If conventional treatments do not offer solutions for certain patients, Mayo Clinic experts dig deeper. "The research idea emerged out of the unmet needs for percutaneous therapies in infective endocarditis," says Dr. El Sabbagh. "Conventional treatment options have been antibiotics and cardiac surgery to remove the infective material and achieve infection control. However, there is a large subset of patients with infective endocarditis that do not respond to antibiotics, are not surgical candidates and have had no options to treat their persistent infection. Percutaneous mechanical aspiration emerged as a treatment option, but it wasn't studied on a large scale until this research."
Removing the infection
Percutaneous mechanical aspiration works by inserting a catheter with suction capabilities through the femoral vein or internal jugular vein. "The catheter is steered under echocardiographic guidance toward the vegetation, which is the collection of infective material on a cardiac structure. The catheter aspirates the vegetation material, disrupting the protective layer of clot and enhancing antibiotic effectiveness, as well as lowering the risk of septic pulmonary embolism," says Dr. El Sabbagh.
The collected material is sent to pathology for review, and it can help tailor the antibiotics.
What's next
Looking to the future, further study is still needed. "The research showed that this procedure is associated with a high rate of success and effectiveness," says Dr. El Sabbagh. "It paves the way for a clinical trial, which is needed to validate the results of our study and help get this procedure wide adoption, so it becomes part of the treatment paradigm of infective endocarditis."
For more information
Refer a patient to Mayo Clinic.