TOPLINE:

In patients with vegetative endocarditis related to cardiac implantable electronic devices (CIEDs), extracting the lead along with percutaneous mechanical debulking via vacuum aspiration of lead-associated vegetations was feasible, involved no major procedural complications, and was followed by a decrease in the count of white blood cells.

METHODOLOGY:

• The incidence of infections related to CIEDs is increasing. For patients with large lead-related vegetations with high risks for morbidity and mortality, transcatheter vegetation debulking has emerged as a less invasive alternative to open heart surgery.
• Researchers retrospectively reviewed 42 transvenous extractions of leads performed in patients with vegetative endocarditis related to CIEDs at three centers across the US and Canada between April 2015 and February 2025.
• Leads were extracted with percutaneous mechanical debulking of vegetative material in 13 patients and via conventional extraction without debulking in 29 patients (mean ages, 59.4 and 63.1 years, respectively; 30.8% and 20.7% women, respectively).
• The mechanical debulking procedure was performed for lead-related vegetations greater than 1 cm in diameter. A suction cannula was passed via the femoral vein to the infected lead, a handheld vacuum aspirated the vegetations, and the leads were removed.
• Researchers assessed procedural outcomes and complications, changes in white blood cell count, length of hospital stay, and mortality rates among other parameters.

TAKEAWAY:

• Patients did not experience any major procedure-related complications, whether they underwent mechanical debulking or conventional extraction. Complete debulking was achieved in all patients who underwent the mechanical procedure.
• White blood cell count decreased 8.4% in patients who underwent mechanical debulking, whereas it increased 21.1% in those who underwent conventional extraction (P = .046), although the count prior to the procedure was higher in those who underwent debulking (15.3 vs 9.9 × 10⁹/L; P = .02).
• Hospital stays tended to be shorter among survivors who underwent mechanical debulking than among those who underwent conventional extraction, although the difference was not statistically significant (mean days, 8.2 vs 15.8; P = .056).
• At 1 month, none of the patients who underwent mechanical debulking died in the hospital, whereas four patients who underwent conventional extraction died. The difference was not statistically significant (P = .401).

IN PRACTICE:

“Although the ultimate methodology for vegetation debulking (vacuum assisted vs mechanical) may depend on multiple factors (mainly logistical), the experience with mechanical debulking shows that this procedure is feasible, easy to plan, safe, and associated with improved outcomes compared with conventional [transvenous lead extraction] without [percutaneous mechanical debulking],” the researchers reported.

“Overall, the current study adds much needed data to the field of device extraction. However, the quality of data related to device extractions remains in its infancy. Large-scale studies, particularly randomized control trials, are needed to evaluate the safety and efficacy of technology related to CIED extraction,” Amier Ahmad, MD, and Rahul N. Doshi, MD, wrote in an editorial accompanying the journal article.

SOURCE:

This study was led by Yury Malyshev, MD, of Mount Sinai Fuster Heart Hospital in New York City. It was published online on September 29, 2025, in The Journal of the American College of Cardiology.

LIMITATIONS:

This study was retrospective, nonrandomized, and had a small sample size. The leads were implanted recently in the patients; thus, the risk profile may have been relatively low. Routine pre- and post-procedural imaging for embolism was lacking, and long-term follow-up data were unavailable.

DISCLOSURES:

One author reported serving as a consultant for and having equity in multiple medical devices and healthcare companies, including Ablacon-Cortex, CardiaCare, and Sirona Medical. Several other authors reported receiving royalty payments, serving as consultants, receiving grants, and/or having other financial ties with multiple sources, including Boston Scientific, Abbott, and Field Medical.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.