Vacuum Extraction of Intracardiac Masses

The management of intracardiac masses is clinically challenging. Much of the difficulty arises from the fact that it is often difficult to describe the precise character and location of cardiac masses by current imaging techniques. Possible causes of intracardiac masses typically include tumor, thrombus, vegetation, or foreign body. Therefore, traditional management of cardiac masses often has included a trial of anticoagulation and eventual surgical embolectomy. However, many patients with cardiac masses are too ill for surgical embolectomy, or their comorbidities make a surgical approach exceedingly high risk. Furthermore, given that thrombus may be difficult to distinguish from tumor, clinicians are often challenged with a choice of sending a patient for cardiac surgery who may only need anticoagulation. Therefore, physicians are increasingly turning to percutaneous vacuum-assisted approaches for removal of unwanted intracardiac material. When percutaneous approaches are attempted, the use of real-time, three-dimensional (3D) transesophageal echocardiography (TEE) is vital for procedure efficacy and safety.

Angiovac

The AngioVac system (AngioDynamics) is a negative-pressure device designed to assist in the removal of intravascular material ( Fig. 174.1 ). The suction for the system is created with the assistance of a centrifugal pump system that is typically used for extracorporeal bypass. This pump can create up to 80 mm Hg of suction at high flow. The suction, or outflow, cannula is 22 Fr and has a balloon-actuated funnel at its distal tip ( Fig. 174.2 ). This cannula is delivered to the heart through a 26-Fr sheath inserted in either the right internal jugular vein or either of the common femoral veins. To avoid massive blood loss, the system is designed to reinfuse blood via a second venous cannula, typically a 17-Fr sheath that inserted in the contralateral femoral vein. All blood is passed through a thrombus filter before reinfusion.

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