Right-sided infective endocarditis is a common entity for which surgical intervention is frequently high-risk. Considering its invasive nature, potential complications, and challenging patient population, a less invasive endovascular option is desirable. The previous series have demonstrated the feasibility of percutaneous therapy for tricuspid valve (TV) vegetation utilizing a filter-based bypass circuit. However, the limited availability of a specialized team, resources, procedural complexity, and large bore sheath size restrict the broad adoption of this technique. The Inari FlowTriever System (Inari Medical) is an endovascular, catheter-based, aspiration, and mechanical thrombectomy system indicated for the removal of large-volume venous thrombus and pulmonary emboli. Independent of anesthesia, perfusion, or advanced imaging, this device's characteristics uniquely improve the operator's ability to safely remove unwanted debris from complex anatomy. This report describes the first, utilization of the Inari FlowTriever System for the removal of massive and inoperable TV vegetation.

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http://dx.doi.org/10.1002/ccd.30294DOI Listing

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Key Steps: General anesthesia and transesophageal echocardiogram guidance; ultrasonography-guided femoral vein access, preclosure sutures, and insertion of a 24-F sheath; insertion of straight 24-F aspiration cannula over a stiff wire, parked in the superior vena cava; introduction of a 20-F curved cannula inside the 24-F cannula to create a telescopic assembly; accurate positioning using the right ventricle inflow/outflow projection in biplane mode; adjustment of the curved cannula radius by sliding the inner cannula in and out inside the mother cannula; manual aspiration of the vegetation; Postaspiration transesophageal echocardiogram assessment.

Potential Pitfalls: Avoid leaflet and annular injury and account for potential embolization.

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