UH Harrington Heart & Vascular Institute First in U.S. to Report New Minimally Invasive Approach for Infective Endocarditis

Monday, November 15, 2021

Novel technique published in Catheterization & Cardiovascular Interventions

A team of interventional cardiologists and cardiac surgeons at University Hospitals (UH) Harrington Heart & Vascular Institute are the first in the U.S. to report a safer, minimally invasive strategy for removing infections in the heart associated with right-sided infective endocarditis. Their technique is now published in Catheterization & Cardiovascular Interventions, a journal from the Society for Cardiovascular Angiography & Interventions.
 
This new strategy treats the infection using the Triever system with FLEX technology which was originally designed to treat pulmonary embolism. The procedure is conducted in the catheterization lab on an awake patient – no operating room, intubation or heart-lung bypass machine required. The novel procedure employs intracardiac echocardiography and fluoroscopy guidance which eliminates the need for an uncomfortable tube (transesophageal echocardiography) down the patient’s throat.
 
Mehdi Shishehbor, DO, MPH, PhD, President of UH Harrington Heart & Vascular Institute and the Angela and James Hambrick Master Clinician in Innovation, and his team have completed more than a dozen successful cases at UH Cleveland Medical Center.
 
This type of heart infection is commonly treated using two less-than-ideal surgical and interventional options: open-heart surgery and AngioVac. Open-heart surgery is invasive and involves significant recovery. The AngioVac system requires general anesthesia in the operating room, as well as a full heart and lung machine. Additionally, it is not easily maneuvered within the heart.
 
“The beauty of using the Triever technology for this purpose is that it can be done on an awake patient, does not require a heart-lung machine, does not require general anesthesia, and the procedure takes about 20 minutes,” said Dr. Shishehbor. “I was optimistic that given my experience, we’d be able to use this new Triever technology in a much safer way, less intensive way, to be able to clear infections. We first offered it to a patient who was not a good surgical candidate, and we were surprised at how effective it was.”
 
Patients who need this type of intervention have commonly contracted an infection from dialysis, enduring catheters, or IV drug use.
 
The popularization of this technique could represent a paradigm shift in treating right-sided infective endocarditis, especially among IV drug users. These patients often have infections cleared via open-heart surgery or interventional cardiology procedure, only to have infections recur due to relapsed IV drug use. This makes them poor candidates for a second operation if needed.
 
“This is a true revolution in treating these patients,” said Yasir Abu-Omar, MD, Director of Cardiothoracic Transplantation and Mechanical Circulatory Procedures at University Hospitals. “We no longer have to go directly to surgery. We can try this approach first, treat the infection, get the patients discharged from the hospital and get them into substance abuse therapy. If they’re doing well, then no further surgery is needed. However, if we confirm they need an operation, we can offer that after rehabilitation. It’s a true paradigm shift.”
 
Having a minimally invasive first option for these patients is critical since many are not ideal surgical candidates.
 
“It’s early, and we need more data, but in our hospital here at UH, it has changed clinical practice for all of these patients,” said Dr. Shishehbor. “As we provide more data, we expect that hospitals will be making this change across the United States.”
 
Dr. Shishehbor and his colleagues have launched a multi-site registry to further evaluate the potential of this new minimally invasive intervention.
 
For more information on this new minimally invasive approach to infective endocarditis pioneered at UH Harrington Heart & Vascular Institute, please call 216-844-4004.
 
You can read “Novel Intracardiac Echocardiography-Guided Catheter-Based Removal of Inoperable Tricuspid Valve Vegetation” in Catheterization & Cardiovascular Interventions by clicking here.

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