Percutaneous Debulking of Bioprosthetic Mitral Valve Vegetations: Preserving Valve Function in Recurrent Infective Endocarditis.

ABSTRACT:

Background

Infective endocarditis involving a prosthetic mitral valve carries high morbidity, especially when complicated by embolic events. Repeat surgery is often not feasible in high-risk patients.

Case summary

An 81-year-old man with a mitral valve bioprosthesis presented with recurrent infective endocarditis due to Streptococcus mutans, with enlarging vegetations and embolic strokes. Given prohibitive surgical risk, he underwent successful percutaneous debulking using the AngioVac system via transseptal approach under transesophageal echocardiographic and fluoroscopic guidance. Long-term suppressive antibiotics were continued. At the 30-month follow-up, the valve was structurally intact with no evidence of recurrent endocarditis.

Discussion

This case highlights the utility of AngioVac debulking of left-sided prosthetic valve vegetations in nonsurgical candidates. Successful imaging-guided aspiration minimized embolic risk and preserved valve function.

Take-home message

Vacuum-assisted debulking with AngioVac via a transseptal approach is a viable option in high-risk patients with prosthetic mitral valve endocarditis, offering an alternative to reoperation.

SUBMITTER: Al Asmari A 

PROVIDER: S-EPMC12905697 | biostudies-literature | 2026 Feb

REPOSITORIES: biostudies-literature