THE CLEAR-IE study indicates that percutaneous mechanical aspiration (PMA) offers significant clinical efficacy for patients with right-sided infective endocarditis (RSIE) who do not respond to medical therapy, leading to improved infection clearance and reduced mortality.
Right-sided infective endocarditis (RSIE) is an increasingly prevalent condition, often seen in patients who inject drugs or have cardiovascular implants. Medical treatment alone often proves insufficient, and surgical intervention carries significant risks. The CLEAR-IE study, presented at TCT 2024, examined the real-world safety and effectiveness of PMA for treating patients with persistent RSIE. This multicenter, retrospective analysis focused on 256 patients from 19 US centres who underwent PMA between 2014 and 2024. The primary goal was to assess infection clearance and procedural safety, with a particular focus on mortality rates. Results showed that PMA was highly effective, with 92.4% of patients achieving culture clearance and 89.4% achieving a significant reduction in vegetation size. However, the procedure’s safety was mixed, with 18% of patients experiencing adverse outcomes such as death, pulmonary embolism, or the need for emergency surgery.
The study found that PMA is a viable treatment option for RSIE, particularly in patients where traditional medical therapy has failed. Culture clearance was associated with a significant reduction in hospital mortality, highlighting the procedure’s potential to improve patient outcomes. However, procedural safety remains a concern, with factors such as baseline hypoxia, shock, and right ventricular dysfunction increasing the risk of adverse events. The study’s findings emphasise the need for multidisciplinary care, including addiction medicine specialists, to manage the underlying causes of RSIE and ensure long-term success. Future clinical trials, particularly randomised controlled studies, are needed to strengthen the evidence base and refine patient selection criteria.
The results of the CLEAR-IE study provide hope for patients with RSIE who have not responded to conventional treatments. Clinicians should consider PMA as a potential option in these difficult cases, but careful patient selection and further research into the procedure’s long-term outcomes are essential for optimising care and minimising risks.
Reference
El Sabbagh A. Outcomes of percutaneous mechanical aspiration of right-sided infective endocarditis. TCT, 30 October, 2024.
