Percutaneous mechanical aspiration in tricuspid valve infective endocarditis

Tricuspid valve infective endocarditis (TVIE) is increasing, largely driven by rising injection drug use and the expanding use of cardiac implantable electronic devices (CIEDs). Percutaneous mechanical aspiration (PMA) has emerged as a viable catheter-based therapy to achieve source control through vegetation debulking in patients with a suboptimal response to antimicrobial therapy or those deemed at high risk for surgery. An expanding literature has demonstrated favorable feasibility and promising outcomes, and recent societal guidelines recognized PMA as a therapeutic option for carefully selected cases. Optimal results rely on multidisciplinary evaluation, rigorous patient selection, appropriate device choice, and meticulous procedural technique. This review summarizes the growing evidence base, outlines patient selection and technical considerations, and highlights future directions for PMA in the management of TVIE.