Minimally invasive management of bioprosthetic tricuspid valve endocarditis with hemodynamically significant tricuspid stenosis using AngioVac: A case report

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We report the case of a 44-year-old male with sepsis secondary to Streptococcus oralis bacteremia complicated by bioprosthetic tricuspid valve endocarditis and severe, symptomatic tricuspid stenosis. Due to significant comorbidities and ongoing polysubstance abuse, initial vegetation debulking using the AngioVac F22 (Angiodynamics NY, USA) mechanical aspiration system was pursued prior to consideration of re-do surgical tricuspid valve replacement. Mechanical aspiration successfully removed the majority of the large valve vegetation, resulting in significantly improved tricuspid valve gradients. This case highlights the AngioVac system's clinical utility in reducing the hemodynamic consequences of large valvular vegetations in high surgical risks patients. • Expanding Treatment Options : AngioVac offers a minimally invasive alternative to surgery for high-risk patients with bioprosthetic tricuspid valve endocarditis (BTVIE). • Improvement in Hemodynamic Outcomes : AngioVac reduced tricuspid valve gradients and relieved severe valvular stenosis without surgery. • Innovative Endocarditis Management : The use of AngioVac can expand therapeutic options for BTVIE. • Addressing a Gap in Current Guidelines : Current guidelines do not provide clear recommendations for managing BTVIE in patients with prohibitive surgical risk. • Clinical Applicability and Future Directions : Future studies are needed to define optimal patient selection and procedural timing for AngioVac use in valvular endocarditis.