Percutaneous mechanical aspiration (PMA) has emerged as a potential alternative to medical
therapy for tricuspid valve endocarditis (TVE), particularly in patients considered high risk for
surgery. In a systematic review and meta-analysis presented at the EuroPCR 2026, investigators
compared outcomes between PMA and optimal medical therapy (OMT) in patients with TVE.

The analysis followed PRISMA methodology and included observational and comparative
studies identified through PubMed, Scopus, Embase, Cochrane Library, and Web of Science
through August 2025. Statistical analyses used random-effects models, with heterogeneity
assessed using the I² statistic. Sensitivity analyses were performed to identify sources of
variance.

Findings

• Four comparative studies involving 24,993 patients were included in the meta-analysis.
• Among these, 634 patients underwent PMA and 24,359 received medical therapy alone.
• In the primary pooled analysis, all-cause mortality did not differ significantly between PMA and OMT (RR 0.83; 95% CI 0.43-1.61; p=0.09; I²=53.6%).
• Leave-one-out sensitivity analysis excluding the El Dalati 2024 cohort eliminated heterogeneity (I²=0%).
• After exclusion of that study, PMA was associated with lower all-cause mortality compared with medical therapy (RR 0.60; 95% CI 0.41-0.89; p=0.012).
• Endocarditis recurrence rates were similar between PMA and OMT groups (RR 1.22; 95% CI 0.81-1.83; p=0.60; I²=0%).
• Median hospital length of stay was numerically longer in the PMA group, although the difference was not statistically significant (MD 5.91 days; 95% CI -2.26 to 14.07).
• Length-of-stay analyses demonstrated substantial heterogeneity (I²=77.3%), potentially reflecting differences in patient complexity and treatment selection.

The findings suggest that percutaneous mechanical aspiration may represent a safe alternative
to medical therapy alone for selected patients with tricuspid valve endocarditis, with sensitivity
analyses indicating potential mortality benefit.