Transcatheter Vacuum-Assisted Mass Extraction versus Surgical Debridement for Vegetations in Tricuspid Valve Infective Endocarditis: A Meta-Analysis of Observational Studies

Tricuspid valve infective endocarditis (TVIE), often associated with vegetation in people who inject drugs, has introduced a less invasive option for vegetation removal: transcatheter vacuum-assisted mass extraction (TVME). This technique is emerging as an alternative to standard surgical debridement (SD) and valve repair. However, the comparative effectiveness of TVME versus SD in treating TVIE has yet to be investigated. A comprehensive systematic literature search was performed on PUBMED, EMBASE, and COCHRANE to identify all relevant studies comparing TVME with SD in patients with TVIE. The search covered studies from inception up to August 15, 2023. For data analysis, Review Manager (RevMan) 5.4 software was employed, using a random-effects model to calculate risk ratios (RR), mean differences, and 95% confidence intervals (CI). Five studies included a total of 431 patients (244 in the TVME arm and 187 in the SD arm). In-hospital mortality (p=0.72), procedural mortality (p=0.77), 30-day mortality (p=0.25), and 1-year mortality (p=0.44) insignificantly favored SD over TVME. Overall mortality across the five studies insignificantly favored TVME over SD (RR=0.66, 95% CI 0.31-1.39, p=0.27, I2=57%). When addressing heterogeneity by excluding one study, no statistical significance in the difference between the two arms regarding overall mortality was observed (RR 0.99, 95% CI 0.60-1.63, p=0.97, I2=0%). This meta-analysis of the five observational studies found no significant difference in overall mortality between TVME and SD for the treatment of TVIE. However, prospective randomized controlled trials are necessary to further understand and compare the outcomes of these two approaches.