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Introduction Infective endocarditis (IE) is a devastating and potentially life-threatening condition, with a mortality of 30% (1), which is often treated by a combination of prolonged antibiotics with or without surgery. When IE involves a cardiac implantable electronic device (CIED), percutaneous complete system CIED extraction is required (class I indication). This can be further complicated by the presence of large vegetations, which increase the risk of embolization; vegetations >3cm are advised to have surgical intervention as per the HRS guidelines (2). A novel catheter-based technique to perform percutaneous mechanical aspiration of large vegetations can allow mass debulking and as an alternative to open heart surgery. We report here a summary of the initial experience at a UK cardiac centre using the Angiovac system (Angiodynamics Inc, US).Methods Seven patients underwent percutaneous mechanical aspiration of infective vegetations or large, non-infective thrombus at a tertiary cardiac centre using the AngioVac system, which uses a vacuum-assisted aspiration catheter attached to an extracorporeal blood filtering and reinfusion device (see figure 1). All cases were reviewed by a multidisciplinary heart team to determine suitability and perform preprocedural planning. Procedures were performed under general anaesthetic in a hybrid catheter lab with transoesophageal echocardiography guidance by at least two senior cardiac electrophysiologists with on-site cardiac surgical support, multidisciplinary cardiac catheter lab team and a perfusionist present.Results Indications for vegetation aspiration were CDIE (n=3) or tricuspid valve endocarditis (n=3) and large, non-infective thrombus prior to mitral valve intervention (n=1). Full characteristics are seen in table 1. All patients with CDIE achieved successful device extraction, and 6 of the 7 total attempted cases were performed successfully. The unsuccessful case was attributed to an inability to adequately reach the mass with the Angiovac catheter for complete aspiration and was then treated successfully with antibiotics. Average maximum vegetation diameter of successful cases was 32 mm. One patient experienced worsening TR at the end of the procedure, however there were no other complications and all patients survived to discharge and 30-days.Discussion This case series demonstrates the feasibility of using a novel percutaneous approach to safely and successfully debulk vegetations caused by IE, facilitating high-risk device extractions and reducing the requirement for open-heart surgery, potentially improving safety and cost-effectiveness. Careful, multidisciplinary planning and intraprocedural coordination is crucial to the success of this complex procedure. Our experience supports the increasing use of this technique in the treatment of device-related and valvular IE.Conclusion Percutaneous mechanical aspiration of vegetations is feasible, safe and effective.Abstract 447 Table 1Case details for CDIE casesCase 1Case 3Case 7Age/Gender/Indication22 M; CDIE85M; CDIE43M; CDIEDevice* and maximum lead dwell time (years)Single Chamber ICD;Max. lead dwell time 1.5 yearsDual Chamber ICD:15 yearsSingle Chamber ICD;1 yearOriginal Implant IndicationSecondary prevention ICD (Arrhythmogenic Cardiomyopathy with VT)Secondary prevention ICD (HCM, OOHVFCA)Primary prevention (DCM)Comorbidities and EuroScore IINone;1.28%AF, Severe Mitral MR, Heart failure;7.92%Hypertension, Type 2 Diabetes, Anaemia;1.75%OrganismStaphylococcus CapitisStaphylococcus LugdenensisMSSA, Paenibacillus ihumiiSite and Maximum Size of Vegetation (mm)Lead - Right Atrium; 28 mmLead - Right Ventricle; 30 mmLead – Right Atrium and Ventricle (multiple vegetations); 33 mmProcedure Duration (mins)162219146Complications / 30-day MortalityNoneNoneNonePost-Extraction Device StrategyEV-ICDTemporary pacemaker until TV-ICD re-implantS-ICD implantationAbstract 447 Table 2Case details for non-CDIE casesCase 2Case 4Case 5Case 6Age/Gender41 F60M76F36MIndication for Percutaneous AspirationNative tricuspid valve IENative tricuspid valve IERemoval of large RA mass prior to MTEERNative tricuspid valve IEComorbiditiesPrevious DVT, IVDUHeart Failure, IVDUHeart Failure, Severe MR, Chronic Kidney Disease, Obesity, AnaemiaPrevious tricuspid valve IE, tricuspid valve repair, Previous DVTPre-procedural EuroScore II1.59%5.04%7.66%6.03%OrganismMSSAMSSA, Staphylococcus pyogenes, Moraxella catarrhalis, Morganella morganii, corynebacterium striatum, proteus mirabilisStreptococcus salivariusMSSA, Streptococcus agalactiae, proteus vulgarisSite and Maximum Size of Vegetation (mm)Tricuspid Valve; 39 mmTricuspid Valve (multiple vegetations); 33 mmRight atrium; 26 mmTricuspid Valve; 37 mmProcedure Duration (mins)138232150211Successful Procedure?YesYesYesNoComplicationsNoneWorsening of Severe TR (managed conservatively)NoneNoneAbstract 447 Figure 1The angiovac system (angiodynamic Inc, US)Abstract 447 Figure 2Intraprocedural transoesophageal echocardiography showing large vegetation in right atrium (case 1) (top panel), mid-oesophageal 4-chamber view showing the Angiovac catheter (red arrow) advanced to the site of the mass (centre panel) and post-debulking (bottom panel)