Percutaneous Mechanical Aspiration of Left-Sided Intracardiac Masses for Prohibitive Surgical Candidates: A Single-Center Experience.

Background: Percutaneous mechanical aspiration (PMA) of intracardiac masses is mostly described for right-sided lesions. Left-sided masses are typically managed medically or surgically, with limited data regarding transcatheter removal. PMA is currently considered off-label; however, it may have advantages to debulk lesions and reduce morbidity in high risk patients. Methods: We performed an observational study of 7, prohibitive surgical candidates who underwent transseptal PMA of mitral valve (MV) masses. Baseline characteristics, echocardiographic findings, procedural details, and in-hospital and short-term outcomes were collected. The primary procedural efficacy end point included procedural success defined by ≥70% mass removal and procedure-related mortality. The primary composite safety end point included in-hospital mortality, cerebrovascular accident, increased valvular regurgitation, and major structural complications. Results: A total of 7 patients were included. The mean age was 77.9 ± 6.1 years; 71% were women, and the median predicted Society of Thoracic Surgery mortality score was 19.5%. All patients had echocardiographic evidence of large (>1 cm) left-sided masses involving the MV or adjacent structures. The primary efficacy end point was seen in 100% of cases. The primary composite outcome was seen in 14.3%, driven by worsening MV regurgitation. Procedure and fluoroscopy durations demonstrated a downward trend with increased experience. All patients survived to discharge and 30-day survival was 85.7%, with 1 noncardiac death. Conclusions: Transseptal PMA is feasible for debulking of MV masses in prohibitive surgical candidates. In this early experience, the technique achieved success with low procedural morbidity and encouraging short-term outcomes. Larger studies are needed to define patient selection criteria and long-term efficacy.